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Property of the 

Lancaster City and County 
Medical Society 



No. 



N-Vt-* 



- ,<•/ 



THE 



AMERICAN JOURNAL 



or THE 



MEDICAL SCIENCES. 



EDITED BY 

ISAAC HAYS, M.D., 

SURGEON TO WILLS HOSPITAL, 

PHYSICIAN TO THE PHILADELPHIA ORPHAN ASYLUM, &C. &C. 



NEW SERIES 

VOL. IV. 



PHILADELPHIA; 
LEA & B L A N C H A R D 

LONDON: 
WILEY & PUTNAM: 

1S42. 



69431 



Entered according to Act of Congress, in the year 1842, by 

LEA & BLANCHARD, 

In the office of the Clerk of the District Court for the Eastern District of 

Pennsylvania. 




T. K. & P. G. COLLINS, PRINTERS. 






TO SENDERS AND CORRESPONDENTS. 



Communications have been received from Drs. Gibson, Earle, Arnold, Met- 
tauer, Nott and Henkel. 

Dr. Taylor's article vi^as crowded out of the present number. 

The following works have been received: — 

Traite Pratique sur les Maladies des oiganes Genito-urinaires, par le Docteur 
Civiale. Deuxieme partie Maladies du col de la vessie et de la prostate; avec 
cinq planches. Paris, 1841. Troisieme et derniere partie Maladies du corps 
de la vessie. Paris, 1842. (From the Author.) 

The Pharmacopoeia of the United States of America. By Authority of the 
National Medical Convention, held at Washington, A. D. 1841. (From the 
Committee of Publication.) 

A memoir on the Fossil Reptiles of the Southeast of England. By G. A. 
Mantell, Esq., LL. D., F. R. S., &c. London, 1841: 4to. (From the Author.) 

A Popular Treatise on Vegetable Physiology. Published under the auspices 
of the Society for the Promotion of Popular Instruction. With numerous cuts. 
Philadelphia: Lea & Blanchard, 1842. (From the Publishers.) 

Twenty-fifth Annual Report of the Asylum for the Relief of Persons Deprived 
of their Reason. Philadelphia, 1842. (From Dr. Warrington and Dr. Earl.) 

Quarterly Summary of the Transactions of the College of Physicians of Phi- 
ladelphia. February, March and April, 1842. 

Fifty-fifth Annual Report of the Regents of the University of the State of 
New York. Made to the Legislature, March 1, 1842. Albany, 1842. (From 
the Regents.) "" 

The London Dissector, or Guide to Anatomy, for the Use of Students, com- 
prising a description of the Muscles, Vessels, Nerves, Lymphatics, and Viscera 
of the human body, as they appear in Dissection; with directions for their De- 
monstration. From the first American Edition. Revised and corrected by 
Edw. J. Christy, M. D., Demonstrator of Anatomy in the Univ. of Maryland. 
Baltimore, 1839. 

Lectures on the Diagnosis, Pathology and Treatment of the Diseases of the 
Chest. By W. VV. Gerhard, M. D., Lecturer on Clinical Medicine to the 
Univ. of Penn., &c. Philadelphia: Haswell & Barrington, 1842. (From the 
Publishers.) 

An Historical Sketch of the State of American Medicine before the Revolu- 
tion; being the annual address delivered before the Medical Society of the Slate 
of New York, Feb. 1, 1842. By John B. Beck, M. D., President of the Soci- 
ety, &c. &c. &o. Albany, 1842. (From the Author.) 

Observations on some of the signs of live and still birth, in their applications 
to Medical Jurisprudence. By John B. Beck, M. D., Prof, of Mat. Med. and Med. 
Jurisprudence in College of Phys. and Surg., New York. (From the Author.) 

Report of the Trustees of the New York State Lunatic Asylum, with the 



4 TO READERS AND CORRESPONDENTS. 

documents accompanying the same, pursuant to the act of the Legislature, 
passed May 26th, 1841. Albany: January, 1842. (From D. Russell, Chairman 
of Board of Trustees.) 

Transactions of the Medical Society of the State of New York, vol. v, pt. ii. 
(From the Society.) 

Introductory Lecture delivered in the Castleton Medical College, March 8, 
1842. By James McClintock, M. D., Prof, of Anatomy. Castleton, 1842. 
(From the Author.) 

A Circular Letter to the Physicians of Kentucky. Maysville, 1842. 

Address to the Graduates of the Medical Institution of Geneva College. De- 
livered 25th January, 1842. By C. B. Coventry, M. D., Dean of the Faculty, 
and Prof, of Obstetrics and Medical Jurisprudence. Utica, 1842. (From the 
Author.) 

Annual Catalogue of the Medical Institute of Louisville, session 1841-42, 
and the circular for the ensuing session. Louisville, Ky., 1842. (From the 
Librarian.) 

A.n Address to the Graduates of the Medical Department of the Columbian 
College. By Thomas Miller, M. D., Prof, of Anat. and Physiol., Dean of the 
Med. Faculty. Delivered March 2, 1842. (From the Author.) 

Circular and Catalogue of the Officers, Professors and Students of Willough- 
by University, at Willoughby, Lake county, Ohio. Session 1841-2. Cleave- 
land, 1842. (From the Faculty.) 

Address introductory to the course of instruction in the Anatomical Rooms of 
Geneva Medical College, Nov. 2, 1841. By Sumner Rhoades, M. D., Demon- 
strator of Anatomy. Geneva, 1841. (From the Author.) 

Revue Medicale Francaise et etrangere. Par J. B. Cayol. Nov., Dec. 1841. 
(In exchange.) 

Journal de Medecine et de Chirurgie pratiques a I'usage des Medecins prati- 
ciens. Par Lucas — Championniaire D. M. P. &c. &c. Dec. 1841, Jan. 1842. 
(In exchange.) 

Gazette Medicale de Paris. Oct., Nov., Dec. 1841, Jan. 1842. (In exchange.) 

Journal des Connaissances Medico-Chirurgicales. Publie par MM. A. 
Trousseau, J. Lebaudy, H. Gouraud. Dec. 1841, Jan. 1842. (In exchange.) 

Journal des Connaissances Medicales Pratiques et de Pharmacologic, Nov., 
Dec. 1841. (In exchange.) 

Journal de Pharmacie et des Sciences Accessoires. Dec. 1841. (In ex- 
change.) 

Journal de Pharmacie et de Chimie, contenant une Revue de tons les travaux 
publiees en France et a I'Etranger, sur les Sciences Physiques, Naturelles, 
Medicales et industrielles ainsi que le Bulletin des Travaux de la Societe de 
Pharmacie de Paris. Jan. 1842. (In exchange.) 

L'Examinateur Medical. Redacteurs en chef MM. Am. Dechambre et Aug. 
Mercier. Nov., Dec. 1841, Jan. 1842. (In exchange.) 

London and Edinburgh Monthly Journal of Medical Science. Edited by 
John Rose Cormack, M. D. Feb., March, April, May, 1842. (In exchange.) 

Dublin Medical Press. Jan., Feb., March, April, May, 1842. (In exchange.) 

Provincial Medical and Surgical Journal. Edited by Dr. Hennis Green and 
Dr. Streeten. Feb., March, April, May, 1842. (In exchange.) 



TO READERS AND CORRESPONDENTS. 5 

Edinburgh Medical and Surgical Journal. April, 1842. (In exchange.) 

Medico-Chirurgical Review. Edited by James Johnson, M. D., and Henry 
James Johnson, Lect, on Anat. April, 1842. (In exchange.) 

British and Foreign Medical Review. Edited by John Forbes, M. D., &c. 
April, 1842. (In exchange.) 

London Medical Gazette. Jan., Feb., March, April, 1842. (In exchange.) 

The Select Medical Library and Bulletin of Medical Science. Edited by 
John Bell, M. D., &c. &c. April, 1842. (In exchange.) 

Medical Examiner. April, May and June, 1842. (In exchange.) 

The New York Medical Gazette. April, May and June, 1842. (In 
exchange.) 

The Boston Medical and Surgical Journal. April, May and June, 1842. (In 
exchange.) 

The American Journal of Science and the Arts. Conducted by Prof. Silliman 
and Benj. Silliman, Jr. April, 1842. (In exchange.) 

The Western Journal of Medicine and Surgery. Edited by Drs. Drake, Yan- 
dell and Colescott. March, April, 1842. (In exchange.) 

The New York Lancet. Edited by J. A. Houston, M. D. April, May, and 
June, 1842. (In exchange.) 

The Western and Southern Medical Recorder. Edited by J. C. Cross, M. D., 
Prof, of Inst. Med. and Med. Jur. in Trans. University. April, May 1842. 
(In exchange.) 

The American Journal of Pharmacy. Published by the Philadelphia College 
of Pharmacy. Edited by Jos. Carson, M. D., and Robert Bridges, M. D. 
April, 1842. (In exchange.) 

The New England Quarterly Journal of Medicine and Surgery. Edited by 
C. E. Ware, M. D., and Saml. Parkman, M. D. July, 1842. (In exchange.) 

The Western Lancet, devoted to Medical and Surgical Science. Edited by 
Leonidas Moreau Lawson, M. D. May, June, 1842. (In exchange.) 

The American Journal and Library of Dental Science. June, 1842. (In 
exchange.) 

A Practical Treatise on Medical Inhalation, with numerous cases demon- 
strating the curative powers of the local application of various remedies in 
Bronchitis, Consumption, and other Diseases of the Respiratory Organs; em- 
bracing the opinions and experience of Rush, Sir Charles Scudamore, Eberle, 
Mudge, Crichton, Thomas, Corrigan, Ramadge, and others. By Edward Jen- 
nerCoxe, M.D. Philadelphia: J. Dobson, 1841. (From the Publisher.) 

Ornithology: The Natural History of Birds. Third Book of Natural His- 
tory, prepared for the use of Schools and Colleges. By W. S. W. Ruschen- 
berger, M. D., Surgeon U. S. N., &c. &c. From the text of Milne Edwards 
and Achille Compte. Philadelphia: Turner & Fisher, 1842. (From the Pub- 
lishers.) 



Communications intended for publication, and Books for Review, should be 
sent,/ree of expense^ directed to Isaac Hays, M. D., Editor of the Amer. Journ. 
of Med. Sci., care of Messrs. Lea & Blanchard, Philadelphia. Parcels directed 
as above, and sent (carriage paid) under cover, to John Miller, Henrietta Street, 

1* 



6 TO READERS AND CORRESPONDENTS. 

Covent Garden, London, or to Wiley & Putnam, New York, or W. D. Ticknor, 
Boston, will reach us safely. We particularly request the attention of our 
foreign correspondents to the above, as we are often subjected to unnecessary 
expense. Some time since we received from New York, through the post 
office, a parcel, bearing the seal of the Royal Society of Northern Antiquaries, 
(Copenhagen,) the postage of which was twenty-six dollars, and of course we 
were compelled to refuse it. Had it been sent under cover to Messrs. Wiley & 
Putnam, the expenses would have been but a trifle. 

All remittances of money and letters on the business of the Journal, should be 
addressed exclusively to the publishers, Messrs. Lea & Blanchard. 



CONTENTS 



AMERICAN JOURNAL 

OF THE 

MEDICAL SCIENCES. 

No. V, NEW SERIES. 

JULY, 1842. 

ORIGINAL COMMUNICATIONS. 

MEMOIRS AND CASES. 

ART. PAGE. 

I. Experiments on Kiesteine, with observations on its application to the 
diagnosis of Pregnancy. By Elisha K. Kane, M. D. - - - - 13 

II. Case of Complete Anchylosis — in which the Knee-joint was permanent- 
ly flexed — cured by an operation. By Wm. Gibson, M. D., Professor 
of Surgery in the University of Pennsylvania. Reported by Thomas L. 
Walker, M. D., of Albemarle, Virginia, one of the resident Physicians 

of the Philadelphia Hospital. [With two wood cuts.] - - - 39 

III. Practical observations on those Malformations of the Male Urethra 
and Penis, termed Hypospadias and Epispadias, with an Anomalous 
Case. By John P. Mettauer, M. D., of Prince Edward county, Virginia. 
[With three wood cuts.] 43 

IV. Cases of Disease of the Brain and Spinal Marrow. By James 
M'Naughton, M. D., Professor of Theory and Practice of Medicine in 

the Albany Medical College. .- -57 

V. Cases of Deformity from Burns, relieved by Operation. By Thos. 
D. Mutter, M. D., Professor of Surgery in Jefferson Medical College, 
Philad., &c. [With eight wood cuts,] 66 

VI. Case of Gun-shot Wound of the Face, with loss of a great propor- 
tion of the Tongue, and extensive lesion of the bony structure, success- 
fully treated; together with an account of interesting nervous phenome- 
na, resulting from the injury. By J. F. Peebles, M. D., Petersburg, Va. 80 

VII. Two Cases of Inversion of the Uterus. By W. L. Sutton, M. D., of 
Georgetown, Ky. 83 

VIII. Case of Extravasation of Blood into the cellular texture, beneath the 
skin of the Penis. By Edward Jarvis, M. D., Louisville, Kentucky. - 85 

MEDICAL EDUCATION AND INSTITUTIONS. 

IX. On the condition of the Profession on the eastern coast of South Ame- 
rica, and the prevalent Diseases of that country. By H. Pleasants, M. 

D.5 of West Philadelphia. - 88 

REVIEWS. 

X. Traite des Nevralgies, au affections douloureuses des nerfs. Par F. L. 
I. Valleix, Medecin du Bureau Central des Hopitaux, &c. Paris, 1841, 
1 vol. 8vo. pp. 719. 

A Treatise on Neuralgia. By F. L. I. Valleix, Physician to the " Bureau 
Central" of the Hospitals, &c. Paris, 1841, pp. 719, 8vo. - - - 95 



8 CONTENTS. 

XT. The Climate of the United States and its Endemic Influences. Based 
chiefly on the Records of the Medical Department and Adjutant-Gene- 
ral's Office, United States Army. By Samuel Forry, M. D. New York, 
1842: 8vo. pp. 378. - 110 

XII. A System of Midwifery, with numerous wood cuts. By Edward 
Rigby, M. D., &c., with Notes and additional illustrations. Philadel- 
phia, Lea^ Blanchard, 1841: 8vo. pp. 491. 123 

BIBLIOGRAPHICAL NOTICES. 

XTII. Lectures on the Diagnosis, Pathology and Treatment of the Dis- 
eases of the Chest. By W. W. Gerhard, M. D., Lecturer on Clinical 
Medicine to the University of Pennsylvania, &c. &c. Philadelphia: 
^ Haswell & Barrington, 1842, 8vo. ^135 

XIV. 1. Second Annual Report of the Directors of the Marine Insane Hos- 
pital. December, 1841. Augusta, Me., 1841, pp. 56. 

2. Ninth Annual Report of the Trustees of the State Lunatic Hospital, 
at Worcester, (Mass.) December, 1841. Boston, 1842, pp. 102. 

3. State of the New York Hospital and Blooraingdale Asylum, for the 
year 1841. New York, 1842, pp. 132. 

4. Twenty-fifth Annual Report on the State of the " Asylum for the Re- 
lief of Persons deprived of the use of their Reason." Philadelphia, 
1842, pp. 30. 

5. Third Annual Report of the Directors and Superintendent of the 
Ohio Lunatic Asylum, to the Fortieth General Assembly. Columbus, 
(Ohio,) 1841, pp. 60. 

6. Annual Report of the Court of Directors of the Western Lunatic 
Asylum, to the Legislature of Virginia; with the Report of the Phy- 
sician, for 1841. Richmond, Va., 1842, pp. 80. 

7. Report of the Superintendent of the Eastern Lunatic Asylum, Wil- 
liamsburg, Virginia, from July 1st, 1841, to December 31st, 1841. 

8. Extracts from a Lecture on Insanity; delivered before the Young 
Men's Association of the city of Utica. February 18th, 1842. By 
C. B. Coventry, M. D. 

9. What shall we do with the Insane of the Western Country? By 
Edward Jarvis, M. D. 

10. Fifth Annual Report of the Trustees of the Vermont Asylum for the 
Insane. October 25th, 1841. 

11. Report of the Trustees of the State Lunatic Asylum, with the docu- 
ments accompanying the same, to the Legislature of the State of New 
York, pp. 203. 136 

XV. The Pharmacopoeia of the United States of America, by authority of 
the National Medical Convention held at W^ashington, A. D. 1840: 8vo., 
Grigg & Elliott, 1842. 143 

XVI. On Regimen and Longevity; comprising Materia Alimentaria, Na- 
tional Dietetic usages, and the influence of Civilization on Health and 
the Duration of Life. By John Bell, M. D., &c. Philadelphia: Has- 
well & Johnson, 1842, 12mo. pp. 420. 145 

XVII. Guide du medecin practicien ou resume general de pathologie in- 
terne et de tlierapeutique appliquees. 

The Practitioner's Guide; a Practical Compendium of internal Pathology 
and Therapeutics. By F. L. I. Valleix. Paris, 1841, Nos. 1 and 2. - 147 

XVni. Quarterly Summary of the Transactions of the College of Physi- 
cians of Philadelphia. February, March, April, 1842, 8vo. p. 24. -148 

XIX. Transactions of the Medical Society of the State of New York. Vol. 

V, Part II. 149 

XX. Annual Report of the Surgeon-General of the United States Army. - 150 

XXI. On the Physical Alterations of the Blood and Animal fluids in dis- 
ease. By M. Andral. 151 



CONTENTS. 



SUMMARY 



IMPROVEMENTS AND DISCOVERIES 
MEDICAL SCIENCES. 



IN THE 



FOREIGN INTELLIGENCE. 



Anatomy and Physiology. 



PAGE 

1. Abstract of Mr. Goodsir's paper 
on the Ultimate Secreting- Struc- 
ture, and on the laws of its 
Function. - . - - 155 

2. Structure of the Human Kidney, 
and the changes it undergoes in 
the granular degeneration. By 
Mr. Goodsir. - - - - 156 

3. Arrangement of the eighth pair 

of Nerves. By Mr. Spence. - 158 

4. Singular case of Monstrosity. 

By Dr. Rodenstab. - - - 1581 



PAGE 

5. Experiments on the Saliva ob- 
tained from a man labouring 
under fistula of the right parotid 
duct near its extremity. By 
Messrs. Garrod and Marshall. - 158 

6. Observations on Parasitical 
grovi^ths on living animals. By 
Dr. Busk, Esq. - - - 160 

7. Dentition of Children at the 
Breast. By Professor Trous- 
seau. ----- 164 



Materia Medica and Pharmacy. 



8. Styptic effect of Kreasote. By | By M. Meillet. 
Dr. Burdach of Luckan. - - 166 10. Lime Moxa. 

9. Sulpho-Cyanuret of Potassium. I borne. 



By Dr. 



" 166 
Os- 
- 166 



Medical Pathology, Therapeutics, and Practical Medicine. 



11. Five cases of Crowing Inspi- 
ration of Children in the same 
family. By Jonathan Toogood, 
Esq. - . . - 

12. Case of enlarged Thymus 
Gland, producing spasm of Glot- 
tis by compressing the recurrent 
Nerves. By Thomas Mitchell, 
M. D., of Dublin. - 

13. Identityof Cow-pox and Small- 
pox. By Dr. Muhry, of Hano- 
ver. - - _ - - 

14. Vaccination in France in 1840. 
By M. Gauthier de Claubry. - 

15. Sciatica cured by Extract of 
Belladonna. By M. Hiriart. - 

16. On the incipient stage of Can- 
cerous Affections of the Womb. 
By Dr. W. F. Montgomery. 

17. (Edema of the Glottis. By 
M. Bricheteau. - - . 

18. Complete obliteration of the 
Aorta. By Prof. Roemer, of 



- 167 



169 

I 
! 

169 
170 

170, 

1711 
172 



Vienna. - - - - 

19. Typhoid fever in the Foetus. 
By Dr. Manzini. - - _ 

20. Tincture of Catechu in fissure 
of the Nipple. 

21. Cases of unexpected recovery 
from large Abscesses in the 
Lungs. By Dr. Graves. 

22. Sympathetic Pruritus. By 
Mr. Walter C. Dendy. 

23. Suffocating Catarrh. By Mr. 
Robinson. - . - . 

24. Cough from Spinal Irritation. 

25. Hiccup from Spinal Irritation. 

26. Asphyxia — the relative import- 
ance of warmth and cold to the 
surface. - - - . 

27. Extensive Disease of the Pan- 
creas. By James A. Wilson, 
M. D. 

28. Influence of venereal excesses 
in the production of Apoplexy. 

By Dr. Muynch. - - - 179 



173 



173 



- 173 



- 174 

Y 

- 174 

176 
176 
176 



- 176 



178 



10 



CONTENTS. 



Surgical Pathology and Therapeutics, and Operative Surgery. 



page! 

29. Treatment of Strangulated 
Hernia by Opium. By Drs. 
Bell, Davis and Cooper. - - 179 

30. Iodine Injections in the treat- 
ment of Serous Cysts. By M. 
Velpeau. 180 

31. Permanent closure of the jaws 
cured after a lapse of five years 
by division of the masseter mus- 
cle. By Prof. Fergusson. - 180 

32. Formation of an Artificial 
Anus for the relief of Intestinal 
Obstruction. By Mr. T. P. 
Teale. ^ 181 

33. Artificial Anus in lumbar re- 
gion in an infant. By M. 
Amussat. _ - . - 181 

34. Rupture of the Spine, by a vio- 
lent muscular effort. By M. 
Lasalle. - - - - - 181 

35. Wound through the Sternum 
and arch of the Aorta. By Dr. 
Caspar. 182 

36. Treatment of Ulcers between | 
the Toes. By Dr. Schlesier. - 182 

37. Successful amputation in | 
spreading Gangrene. By A. 

T. S. Dodd, Esq. - - - 182 

38. Reunion of the Fingers. M. 
della Fanteria. - . - 184 

39. Varicose crural vein. By Dr. 

de Castella. - - - - 184 

40. Semi-amputation of the Ute- 
rus. By Dr. Grembler, of Neider 
Orschel. 184 

41. Introduction of Air into the 
Veins. By Dr. Godemer. - 184 

42. Necrosis of the Os Calcis. By 

M. Mallespine. - - - 185 



PAGE 



43. Hypertrophied state of a fold 
of the Schneiderian membrane 
mistaken for nasal polypus. 

44. Van Gesscher's Bougies. 

45. Ventral Hernia. . - - 

46. Amputation for diseased bone 
in Children. By M. Tayignot. 

47. Spontaneous Priapism during 
thirty hours, with retention of 
Urine. By M. Demeaux. 

48. Berard's mode of applying the 
Vienna caustic for the cure of 
varicose veins. By M. Berard. 

49. Fracture of the neck of the 
Femur. By Mr. B. Cooper. 

50. Dislocation of the Sternum 
By M. Maissoneuve. 

51. Wounds of the Femoral vein in 
operations for Aneurism. By 
Mr. Hadwen. - 

52. Polypi of the Rectum in Chil- 
dren. By Prof. Stolz. - 

53. Cases of double Hare-lip — 
period of life most suitable for 
operating for this deformity. By 
Mr. Houston. - - - 

54. Amputation during Pregnancy. 
By Mr. Tarleton, of Birming- 
ham. - _ - - - 

55. Solution of Urinary Calculi 
By M. Pelouse. 

56. Cauterization of the neck of 
the Uterus. By M. Lisfranc. - 

57. Vesico-vaginal Fistula. By 
M. Leroy d'Etiolles. 

58. Hernia of the Stomach. 

59. Rare form of Internal Strangu- 
I lation. By Prof. Geoghegan. - 



185 
185 
185 

186 



186 



187 



- 187 



- 187 



- 187 



188 



- 188 



192 

- 193 

195 

195 
195 

196 



Ophthalmology. 



60. On certain structures in the 
Orbit, and an improved method 
of treating its Diseases. By J. 
M. Ferrall, Esq. - - 

61. Rupture of the Sclerotica by a 
blow with the Fist. - 

62. Symblepharon. By M. Petre- 
quin, of Lyons. - - - 

63. Turpentine in Scrofulous Cor- 
neitis. By Mr. Obre. 

64. Irideremia. By M. France. - 

65. Imperfect development of the 
Eyes with Cataract. By Mr. 
Walker, of Manchester. - 

66. Cases in which, after the fail- 



ure of the operation for Cataract 

on one eye, the vision of both 

eyes was restored, by operating 

197 on the cataract on the opposite 

side. By M. Serre, Prof, at 

- 201 Montpellier. - - - - 206 

67. Melanosis of the Eye. By 

203 Dr. Byron. - - - - 206 

i68. Cysticerus lodged under the 

205} Conjunctiva. By Dr. Hoering, 

205j of Luisburg. - - - - 211 

69. Cataract suddenly formed in 

boih Eyes. By Dr. Martin, of 

205 Portlaw. 211 



CONTENTS. 



11 



Midwifery. 



PAGE 

70. Extra-uterine Pregnancy. By 

M. Blache. - - - - 211 

71. Number of Pulsations of the 
Foetal Chord. By Mr. Streeter. 212 

72. Rupture of the Womb during 
Gestation — Recovery. By Dr. 
Richter. 212 

73. On the Management of the 
Placenta. By Mr. Joseph Bell. 212 

74. Facts relative to the statistics 

of Menstruation. - . - 213 

75. Extraordinary Birth. By Dr. 
Schnackenberg. - - - 213 



76. Abstraction of the Uterus after 
delivery. By Dr. Peracchi. - 214 

77. Polypusof the Uterus expelled 
by the action of Secale Cornu- 
tum. By M. P. Moyle. - - 214 

78. Pregnancy unattended with the 
usual signs, and in which partu- 
rition occurred without labour- 
pains: rupture of the funis which 
remained untied forty-five mi- 
nutes. By Thomas Lewis, Esq., 
Liverpool. . - . . 216 



Medical Jurisprudence and Toxicology. 



79. Guerard on the consequences 
of drinking cold liquids when 
heated. 

80. Detection of Arsenic acid by 
M. Eisner. - - - _ 

81. On spots in glass resembling 
those of Marsh, produced by a 
reducing flame. By Prof. Lou- 
yet. 

82. Do Metallic poisons when 
mixed with cultivated land, enter 
into the composition of the vege- 
tables produced? By MM. Lou- 
yet and Verver. _ . _ 

83. Superfo3tation. By Mr. Re- 
nauldin. 

84. Plea of Quick with Child in 
criminal cases. By Mr. Grif- 
fiths, of Wexham. - - - 

85. Presence of Lead in the solids 
and fluids. By Dr. Budd. 

86. On a new mode of distinguish- 
ing arsenical spots from antimo- 
nial spots. By M. Bischoff". - 

87. Nicotine. By M. Barral. 

88. Ergot. By Mr. Quekett. 

89. Suicide from Asphyxia by 
choking, from the introduction 
of a firm plug into the fauces. 
By Dr. Handyside, of Edin- 
burgh. - - - . - 



190. Minute quantity of Opium de- 

I structive to the life of a child. 
217! By Mr. Everest. 

91. Signs of Pregnancy. — Kies- 
218 teine. By Mr. Letheby. - 

192. New Test for Nitric Acid. - 

93. Are medical men liable to 
punishment if they refuse to 

218 make a medico-legal dissection, 
or a chemical analysis, when 
called upon by the coroner? By 
Dr. Cambrelin, of Namur 

94. Poisoning with flour contain- 
219j inglead. By Dr. Schillbach. - 225 

95. On the varieties observed in 
2201 the symptoms of poisoning with 

I Opium. By David Skae. - 225 

96. Advanced stage of the Putre- 
220| faction of the Brain, without any 

I corresponding appearances in the 
221 i rest of the body. By M. Millet. 226 
[97. Birth of a living child on the 
1 179th day. By Mr. Tait. - 227 

221 98. Child born at the end of the 



223 

223 

224 



- 224 



222 

222 



222 



fifth month, which lived six 
days. By Dr. John Cochrane, 
of Edinburgh. - - - 227 

99. Recovery from taking two 
drachms of Arsenic. Mr. Too- 
good. - - - - - 228 



Miscellaneous. 



100. Animal Magnetism. By Mr. 
Longmore. - - - - 228 

101. Abstractof a paper on Opium 
smoking in China. By G. H. 
Smith, Esq. - - - _ 229 

102. The Bavarian Schools of 



Medicine suspended. - - 233 

103. Desertion of children in 
France. By MM. Terme and 
Monfalcon. - - . - 233 

104. University College, London. 233 

105. Obituary Record. - - 233 



12 



CONTENTS. 



American Intelligence. 



PAGE 

Expulsion of a mass of hair from 
the Uterus. By Henry R. Frost, 
M.D., Charleston, S. C. - 235 

Case of expulsion of the Foetus 
about the sixth month with the 
membranes entire. By Robert 
S. Bailey, M. D., Charleston, 
S. C. 236 

Statistics of the Medical Colleges 
in the United States. - - 237 

On the Intermittent Fever of New 
England. By Samuel Forry, 
M.D. - - - - - 239 

Nathaniel Chapman, M.D. - 240 

Observations on some of the signs 
of live and still-birth, in their 
applications to Medical Juris- 
prudence By John B. Beck, 
M. D. 243 

Inversion of the Uterus. By D. 
Humphreys Storer, M. D. - 247 

Operation for Artificial Pupil and 
subsequent section of the Rec- 
tus superior. By J. Kearny 
Rodgers, M. D. - - . 248 



PAGE 



Rupture of the Uterus from exter- 
nal injury. By Dr. F. Hyde. - 249 
Ligature of the External Iliac 

Artery. By Dr. E. Peace. - 250 
Excision of a large Tumour upon 
the Neck. By R. D. Mussey, 

M. D. 253 

Thymic Enlargement. By Dr. 

W. C. Roberts. - - - 254 

Blepharoplastic operation for Ec- 
tropion. By Dr. A. C. Post. - 258 
Snake Bites. By Prof. Drake, of 

Louisville. - - - - 258 
Medical Schools of the West. -259 
Assistant Surgeons in the Navy. - 259 
Medical Advertising. - - - 259 
Medical College of Ohio. - - 259 
A Popular Treatise on Vegetable 

Physiology. - - - _ 260 
Philadelphia College of Pharmacy. 260 
University of Maryland. - -260 
Willoughby Medical School. - 260 
Pennsylvania Hospital. - - 260 
Yellow Fever at Key West. - 260 
Obituary, 260 



THE 

AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



JULY, 1842. 



Article L — Experiments on Kiesteine, ivith observations on its ajyplica" 
Hon to the diagnosis of Pregnancy. By Elisha K. Kane, M. D.* 

In 1831, M. Nauche communicated to the Society of Practical Medicine 
of Paris, some observations on a gelatino-albuminous product found in the 
urine of pregnant females subsequent to the first month of gestation, and 
which is separated from the other elements of that fluid by rest alone. To 
this product he gave the name of Kiesteine. 

If the urine, he says, be exposed for a few days in a glass, the kiesteine 
shows itself at the surface, in the form of specks [points) and oblong fila- 
ments, which unite in a pellicle or scum of a line in thickness. A portion 
of this sinks to the bottom of the vessel, and forms there a whitish deposite 
of a milky appearance; the rest remains on the surface, adheres to the sides 
of the glass, and is converted into a solid membraniform substance. 

The pellicle thus formed, he regards as furnishing a certain test of preg- 
nancy almost from its commencement, if the woman is in health; and he 
asserts that he has frequently determined by reference to it the existence of 
that condition, when it would not otherwise have been suspected. He 
admits that in diseases in which there is a secretion of pus, in dropsy, in 
diabetes, and in children having worms, the urine is often covered with 
an albuminous, fatty, or saline scum, resembling somewhat that observed 
during pregnancy; but he affirms that after a litde practice, these are dis- 
tinguishable at a glance. 

M. Nauche was followed by M. Eguisier, of the Sainte Genevieve Dis- 
pensary of Paris, who, in February, 1839, published an article in the Lan- 
cette Frangaise, in which he described the pellicle as observed by himself. 

* This was an inaugural dissertation for the degree of Doctor of Medicine; and is 
published in pursuance of a recommendation of the Medical Faculty of the University 
of Pennsylvania. 

No. VII.— July, 1842. 2 



14 Kane on Kiesteine, . [July 

"From the second to the sixth day," he says, "small opaque bodies are 
seen rising from the bottom to the surface of the liquid; and these aggregat- 
ing by degrees, form a layer which covers the entire surface: this is the 
kiesteine. It has sufficient consistency to admit of being lifted up with 
some care by its edges. It is whitish, opaline and somewhat granulated, 
and may be well compared to the fatty scum of cool broth." He considers 
it an invariable attendant of pregnancy, and so well marked in its distinctive 
characters as to prevent its being readily confounded with others. 

M. Eguisier had examined twenty-five cases. Seventeen of these, at 
periods varying from the fourth to the ninth month of utero-gestation, were 
under his care for slight indisposition: four had been pregnant from one to 
four months, and were under treatment for uterine disease: and the four 
others were affected, respectively, with ascites, sciatica, ulceration of the 
neck, and a supposed uterine disease, for which repeated cauterizations had 
been resorted to. In all of these the characteristic indications of kiesteine 
were present; and in the four last mentioned, the existence of pregnancy 
was ascertained in the first instance by reference to them alone. 

In the following year. Dr. Golding Bird, of Guy's Hospital, published in 
the reports of that institution his paper " on the existence of certain ele- 
ments of the milk in the urine of pregnant women," founded upon the 
observation of " about thirty cases."* He gave succinctly the result of his 
examinations, touched on the microscopic and chemical characters of the 
pellicle, and expressed his belief that it is an imperfect caseous matter mixed 
with crystals of the ammoniacal phosphate of magnesia. Pursuing an idea 
of Professor Burdach of Konigsburg,! that the elements of the milk exist- 
ing in the circulation may, during certain conditions, be eliminated, and not 
finding an outlet by the mammae, be again taken up and excreted by the 
kidneys, he supposes such elements to enter into the constitution of the 
kiesteinic pellicle. 

A still later writer, M. Becquerel,:j: in his " Semeiotique des Urines," has 
noticed the observations of M. Nauche, but without admitting the truth of 
his conclusions. He had, himself, analysed and examined the urine of three 
pregnant females, and had occasionally inspected that of a ^^ certain number" 
in different stages of utero-gestation, without discovering traces of the kies- 
teine. 

I believe that I have referred in this brief sketch to all the personal obser- 
vations which have been published in Europe upon this subject. They 
have of course attracted the notice of the journalists,§ and some of the 

* Guy's Hospital Reports, No. 10, April, 1840. 

t Traile de Physiologie, Paris, 1839. 

^ Semeiotique des Urines, ch. ix., Paris, 1841. 

§ Journal de Chimie Medicale, Fev., 1839, p. 64. London Lancet, No. 417, p. 675. 
Dublin Journal, vol. VI. Medico-Cliirurgical Review, 1839, p. 228. Am. Journ. of Med, 
Sci., Feb. 1840, p. 483; Ibid. Aug. 1840, p. 501. Am. Med. Tntelligencer. 



1843.] Kane on Kiesteine, 15 

more elaborate writers of the profession have alluded to them in their trea- 
tises.* 

Some indeed have assigned to the discovery a much earlier date, referring 
it to Savonarola, who, as far back as 1486, detailed minutely a series of 
changes incidental to the urinary excretion from the commencement of 
utero-gestation to the seventh month. I have been unable to obtain a copy 
of this venerable author, and cannot, therefore, speak personally with regard 
to his observations; but I find by reference to Fodere, and others who 
quote his opinions, that after describing the colour of the fluid, he mentions 
a *' cloud upon the surface," adverting at the same time to a deposite par- 
tially suspended resembling carded wool. This description may perhaps 
identify this superficial cloud with the pellicle of M. Nauche. If so, how- 
ever, the question of originality will arise between Savonarola, and some of 
the still more ancient writers of the Moorish and Arabian schools. 

The urine, it is well known, in common with all the excrementitial and 
secreted fluids, was anciently a subject of habitual though vague observa- 
tion. Yet, if we except the increased redness, noticed by Hippocrates and 
some others, as pertaining to the latter months of gestation, nothing can in 
any case be gleaned from the works of ancient writers, by which the phases 
of the urine may be applied to the determination of pregnancy. Thus, 
Galen, Magnus of Antioch, and Pliny, allude in a general and obscure 
manner to the urine and its changes, without referring to the peculiarities it 
exhibits during pregnancy. But Avicenna and Rhazes are quoted by M. 
Eguisier, as describing the white cloud, the central deposite, and the minute 
bodies ascending and descending; not indeed as signs absolutely indicative 
of pregnancy; yet as generally attending it, — the deposite beimg perhaps the 
most constant. 

It may, however, be conceded, that up to the present time, the existence 
and character of these appearances have not been the subject of entirely satis- 
factory investigation. To justify general conclusions, a larger number of cases 
should be examined, individually and in group, and their progress, changes, 
and points of difl"erence noted. They should be viewed under diflferent 
aspects, at regular and frequently recurring intervals. If the indications of 
a particular case should appear to vary from those of others, repeated obser- 
vations would become necessary to detect the causes of variance; and the 
influence of similar causes upon other cases, where they existed, also should 
then be sought for. And I may be excused for adding, that a candid spirit, 
not too much biased in favour of theory to admit the existence of observed 
exceptions, that looks to each clearly ascertained result as an independent 
element, and rejects nothing that appears true because irreconcilable with 
what was known before, is not less important to the formation of correct 
opinions, than the most careful and varied scrutiny of facts. 

* Montgomery, Dunglison, Churchill, Rigby, Traill, &.c. &c. 



16 Kane on Kiesteine. [July 

It is not meant to intimate by this, that the gentlemen who have treated 
on this subject have been regardless of these precautions, or wanting in the 
proper spirit of inquiry; but it is apparent that their observations have been 
rather of isolated cases than of classes, that they have not compared a large 
number of results, and that they have failed to detect any exceptions to their 
general conclusions. 

M. Eguisier speaks of only twenty-five cases, Dr. Golding Bird of 
** about thirty," and M. Becquerel's scrutiny, with immediate reference to 
this question, embraced only three. So that, as to all those who have fol- 
lowed M. Nauche in Europe, it may be said with truth, that the aggregate 
of their observations does not number sixty cases. It should not, therefore, 
surprise us, if a more extended investigation were to lead to a modification 
of their conclusions. 

In the spring of last year, while one of the resident physicians at the Phi- 
ladelphia Hospital, I availed myself of the facilities which were liberally 
afforded me by the managers of that institution, to commence a series of 
observations on the subject of kiesteine; and I have continued them to the 
present time. The number of patients in the several wards was such as to 
make it easy to classify and group the cases, and my position enabled me at 
all times to scrutinize the circumstances of each, much more fully than could 
have been done in private practice. 

My friends, Drs. McPheeters and Perry, who were residents with me at 
the time I began, had already made some interesting observations on the 
subject at the instance of Dr. Dunglison,* which they subsequently published 
in his Medical Intelligencer; but though their politeness had enabled me to 
watch the progress of their investigations, I had not adopted their conclu- 
sions, and was in fact careful to avoid the influence which the known opi- 
nions of others might have had upon the freedom of my own. 

My mode of conducting the experiments was this. The recent urine was 
placed in open glass cylinders, of diameters varying from an inch and a half 
to that of a common tumbler, and protected from dust by paper covers. 
These were arranged in a dry, well ventilated room, where the temperature 
was uniform and moderate, and were exposed in groups to the equal action 
of air and light. f I examined them frequently during the day; but as the 
changes were not rapid, I determined after a little while to note only one set 

* I should do much wrong to my feelinors, were I to pass the name of this gentleman 
without acknowledging the obligations I am under to his unwearying kindness. No one 
promotes more happily a spirit of inquiry among the younger members of the profession, 
or is more prompt to render them service. 

t These precautions were not unimportant. My attempts in the " Green Room of the 
Hospital" were unsuccessful, in consequence of the dampness producing fungoid modifi- 
cations of the scum; and in very cold or very hot weather, the pellicle formed very re- 
luctantly, or was anticipated by the decomposition of the urine. The room should be 
sufficiently lighted to admit of minute examination, and the specimen should be kept 
absolutely at rest during the progress of the inquiry. 



1842.] Kane on Kiesteine, 17 

of observations in the twenty-four hours. My notes were always made 
upon the spot. If from any cause, an individual observation or a series was 
unsatisfactory, or inconclusive; or if it led to a different result from others, I 
repeated it at once with increased care; and I was always careful to observe 
the constitution, habits and circumstances generally of each patient. 

The examination of the first group of cases satisfied me, that the urine 
during pregnancy assumes appearances different from those witnessed under 
other circumstances, and which I was therefore disposed to regard as cha- 
racteristic of that state. Subsequent inquiries confirmed me in the general 
accuracy of this opinion, but compelled me at the same time to admit its lia- 
bility to exception. 

The more obvious of these appearances regard the superficial formation 
described by Dr. Bird, and recently investigated by Drs. McPheeters and 
Perry; but there are others which point to a series of intestine changes 
somewhat more obscure, though scarcely less interesting. My observations 
applied to both; and I regret that the limited time at my command during 
the studies preliminary to graduation, obliges me to select a single class as 
the subject of this dissertation. I take, however, that indication which seems 
to me best fitted for practical usefulness in diagnosis, the pellicular change, 
and which I suppose to be most properly called the Kiesteine. 

The urine, submitted to observation in the way I have described, presents 
but little change during the first thirty-six hours. The mucous flocculi, if 
they exist, gradually subside during this period, forming a whitish cloud- 
like deposite at the bottom and sometimes on the sides of the glass; while 
more or less alteration occurs in the colour and transparency of the fluid. 

The surface remains for a short time entirely unchanged; but in most 
cases, a greater or less number of shining acicular specks, apparently crys- 
talline, begins to be seen within the first eighteen or twenty-four hours. 
These are generally scattered over the surface without regularity; but in 
some rare cases, they are so disposed as to form a translucent film of uni- 
form thickness, which afterwards assumes the more defined characters of the 
pellicle. How far these crystals are essentially connected with the forma- 
tion of the pellicle, X am not prepared to say. In many cases, I have not 
succeeded in detecting their presence, even by the microscope; and, indeed, 
I have failed to discover any unvarying indications whatever of the ap- 
proaching development of the Kiesteine. 

The cloudlike appearance, which is alluded to by Nauche and Eguisier, 
although possessed of much interest, I have not found to be a uniform premo- 
nitor of the forming pellicle; I have supposed it to be nothing more than the 
Enaeorema of the older writers, depending upon the imperfect aggregation of 
mucous flocculi; for I have seen it repeatedly when there was no pregnancy 
to account for it, and it was uniformly absent where the fluid presented per- 
fect transparency. 

The time at which the pellicle begins to form varies considerably. I have 

2* 



18 Kane on Kiesteine. [Jw^y 

seen it well marked at the end of thirty-six hours, and have known it make 
its first appearance as late as the eighth day. At first, it is hardly discern- 
ible. It is generally seen forming at the centre or on the sides of the glass, 
presenting a delicate milky or bluish white aspect. It is however in some 
cases uniformly disposed over the surface from the commencement, and 
assumes the appearance of a nearly transparent film, which gradually be- 
comes more distinct. But it has not always the continuous strongly marked 
character, which some have ascribed to it. I have seen it begin in striated 
irregular lines, somewhat resembling a spider's web, in rings, circles, trape- 
ziums, and irregular figures of almost every shape, which gradually became 
obscured by the full development of the pellicle. 

When it has attained this stage, which occurs generally about the fifth 
day, it presents a continuous scum of an opaline white or creamy appear- 
ance, with a slight tinge of yellow, which gradually becomes deeper and 
more decided. The uniformity of this colour, however, is generally broken 
by granulated spots of a clearer white, giving it a dotted or roughened aspect. 
The crystals of the forming stage now appear like shining points, and I have 
sometimes found numerous small brownish specks, sprinkled over the sur- 
face, not unlike the gratings of nutmeg. It is at this period, that the pel- 
licle may be compared " to the fatty scum of cooled broth." 

In this state it continues for some time, preserving all its characters un- 
broken. The glass, where the surface meets it, is discoloured by a white 
opaline ring; and a series of such rings, varying in extent from a line to the 
fourth of an inch, marks the descent of the surface during the progress of 
evaporation. 

The cheesy odour, mentioned by Dr. Bird as a valuable aid in diagnosis, 
and as " by no means unfrequent in those specimens in which the pellicle is 
very thick," I have found in but seven cases. Many pellicles of great thick- 
ness were entirely without it; and in two of those presenting it, the pellicle 
was thin and not very well developed. Drs. McPheeters and Perry were 
unable to detect it in either of the twenty-seven cases examined by them, 
and I have found it unequivocally developed in at least three cases in which 
pregnancy did not exist. 

The pellicle, if left undisturbed for some days, breaks into cracks, com- 
mencing generally from the central portions, but not always extending to the 
edge of the glass. These are again crossed by other fissures, and the pel- 
licle is more or less broken up. In the mean time, the flakes, which have 
been forming from the commencement of disintegration, have their edges 
depressed into the fluid, while at the same time the general thickness of the 
pellicle is much diminished; and this depression or dip gradually increasing, 
the depending particle is detached, and sinks slowly to the bottom. Its 
complete disintegration, however, is but seldom seen; being anticipated by 
the decomposition of the fluid. The deposite is of course considerably in- 
creased by the fallen portions of the pellicle, and is found irregularly dis- 



1842.] Kane on Kiesteine, 19 

posed over the bottom of the vessel; but as I have remarked, most abundant 
on the side farthest from the light. 

I cannot agree with those who consider this deposite as presenting well 
marked distinctive characters to the eye, and I certainly have not found it 
uniformly coincident with the approach of the pellicle. It has indeed in 
many cases been absent at that period; and in others, until augmented by 
the detached pellicle, I have been unable to distinguish it from the very 
many deposites found in other urine. How far a chemical investigation 
may give it value, I am not prepared to say: although its liability to be con- 
founded with other sediments makes it practically unavailable as a test, it 
offers a fine field for microscopic and chemical research. 

This description of the appearances and changes of the pellicle, though 
more detailed than those of Nauche and his followers, still applies only to 
the better defined examples. In a considerable proportion of cases, some 
of the phases mentioned are not to be found together; and I have not been 
able by the most careful observation to discover the causes of variance. This 
I allude to here, because the absolute and unqualified language, which I have 
met elsewhere upon the subject, seems to me calculated to mislead the un 
practised inquirer. 

It must not however be inferred that the presence of kiesteine is determi- 
nable only by vague and undefined characteristics. On the contrary, the 
tables which are appended to this dissertation, will show that they are as 
well defined as most pathological phenomena, though like them they some- 
times require for their discrimination a practised comparative scrutiny. 

Tlie table marked A exhibits a condensed record of my observations, 
more or less frequently repeated, on the urine of eighty-five pregnant 
females. Of these, as will be seen, sixty-eight gave a well marked pellicle of 
the sort called kiesteinic, eleven gave the pellicle under a modified form, but 
with appearances which enabled me to recognize it clearly, and six gave no 
pellicle whatever. Of these last, one was labouring under mammary abscess 
and convalescing from typhoid fever, and one was in a condition of extreme 
anaemia from repeated uterine hemorrhages; but the others, unless they suc- 
ceeded in practising reiterated deceptions on me, which I can hardly believe, 
must be regarded as absolute exceptions. 

The cases in the table were all of them observed at the hospital, and were 
of course considerably advanced before being submitted to my inspection. I 
have since, by the courtesy of my friends in the city, and especially of Dr. 
N. Benedict, been invited to examine the urine of several patients in cases 
of very recent yet unascertained pregnancies. My diagnosis has been in 
every case successful, and I have detected the kiesteine repeatedly before 
the second period of suspended menstruation. I found it in one of these 
before the fourth, and in another before the fifth week, computed from the 
middle of the preceding period. In several others I have determined it be- 
fore the end of the third month. In one case the kiesteine was not visible 



20 Kane on Kiesteine* [July 

on the fourth, fifth or seventh week, although perfectly manifest on the 
tenth. 

The urine of unimpregnated females in a state of health rarely undergoes 
any change which in this respect can be misapprehended. I have examined 
twenty-eight cases in a perfectly healthy condition, and have sometimes 
known pellicles form on the urine, as well as on that of males; but the dis- 
tinctive character of the kiesteine was wanting in every case. 

In certain pathological conditions, however, discrimination is somewhat 
more difficult. The pellicle that is not unfrequently seen on the urine in the 
last stages of phthisis, in arthritic diseases, and in cases of metastatic ab- 
scess, vesical catarrh, and uterine tumours, has points of resemblance to the 
kiesteinic which might readily mislead the unpractised. With reference to 
this, I have examined a large number of cases in various states of health and 
disease, and noted the results; but it may not be necessary to give more than 
a concise summary of them. 

In thirty cases of phthisis pulmonalis, the urine of four presented a pelli- 
cle somewhat like the kiesteine, and one a pellicle bearing a strong resem- 
blance to it: though, more unequally and irregularly disposed, and thus dis- 
tinguishable by the eye. Fourteen of the cases were in the latter stages of 
the affection, and among these were three that presented the pellicle. 

In arthritic diseases, eight cases of acute rheumatism and a large number 
of chronic rarely presented any well-marked pellicle, and never one that 
could be confounded with the kiesteinic. 

Sixteen females between the ages of sixty and one hundred, as well as 
ten epileptics, presented no change that could give rise to confusion. 

Numerous blennorrhagic and leucorrhoeal cases were likewise examined. 
In the urine of these an increased quantity of mucus was generally present, 
disposed in flocculi, as M. Becquerel and others have noticed, but this 
was by no means uniform. In most of them the pellicle was of a cloudy 
character, much obscured by rapidly induced decomposition. In only two 
of them did it approach in appearance the kiesteine. But in these the 
resemblance was close; the most remarkable difference being in the manner 
of its formation, which was apparently referable to the advance of decompo- 
sition. The pellicle, moreover, was thickened by depending flocculi of 
mucus, which gave to its lower surface an irregular fungiform appearance. 

The particulars in which the kiesteine differs from other pellicles regard 
the manner of its formation and departure, even more than its appearance 
when developed. As I have already mentioned, it generally begins to show 
itself within a day, or at furthest within two days after the discharge of the 
fluid, and advances gradually to its complete development. The other pelli- 
cles, on the contrary, rarely give indications of their approach until the fluid 
has stood a longer time, or even till decomposition has supervened, and then 
form with rapidity. I have known them entirely defined within a few hours. 



1842.] Kane on Kiesteine. 21 

The kiesteinic pellicle, when fully formed, has almost always a much greater 
degree of tenacity than the others: I have often, for purposes of microscopic 
examination, lifted large flakes entirely out of the urine; and when it was 
well defined, this was easily done: with the others it was never practica- 
ble. It seems also to be independent of putrefaction; it is not obscured 
for some time by the disorganization of the liquid on which it rests; and 
the characteristics which I have already described as accompanying its dis- 
appearance are very seldom simulated. 

The appearances which I have observed seem to point directly to the con- 
clusion, that the formation of the kiesteine is unconnected with the presence 
of extraneous pus or flocculent mucus. I was aware that these and other 
animal matters might under certain modifications give rise to a scum upon 
the surface, the " cremor urinae" of the older writers. This has been no- 
ticed by M. Becquerel, as especially observable in leucorrhcea; and I have 
observed it very frequently, not only in that disease, but in cystitis, gonor- 
rhoea, vaginal and uterine hemorrhages, and immediately after delivery 
when the lochial discharge was mingled with the urine. 

By the kindness of Dr. Stewardson, I have had the opportunity of seeing 
M. Becquerel's recent and very elaborate work on the " Semeiology of 
Urines,"* and I have been struck with the discrepancy between his observa- 
tions and my own in several particulars connected with this inquiry. 

After remarking that the urine is modified in its appearances by the con- 
stitutional changes incident to pregnancy, he says, that it often, especially in 
the latter period of gestation, grows palish, diminishes in density, containing 
less solid matter in solution, and partakes of the general anaemic character of 
the patient; and that it also often remains unchanged after exposure. 
Without attempting to deny the presence of the matter denominated kiesteine, 
he is not prepared to admit it, but refers to the " influence of a certain 
quantity of mucus on decomposition" as capable of producing the appearance 
which has been mistaken for it. 

I cannot avoid referring to the results of some experiments, which appear 
to me to be at variance with these suggestions. Many of the specimens 
which I examined had been first submitted to filtration, with a view of sepa- 
rating any mucus they might contain; yet in every case, the pellicle formed 
with the same regularity as when this precaution had not been resorted to. 

It was formed also on urine which, when treated with acetic acid, pre- 
sented no coagulation, and which underwent no change when treated while 
hot with alcohol. And in many cases, where the urine was withdrawn by 
the catheter, and freed of course from the possibility of vaginal extermix- 
ture, the formation of the kiesteinic pellicle was uninterrupted. I can 
scarcely believe, that in such cases it was owing to the presence of the ex- 
traneous mucus. 

* Reviewed in the Number of this Journal for January last. 



22 Kane on Kiesteine, [July 

The observation, too, that the urine becomes paler in the later stages of 
pregnancy has not been confirmed by my experience. The urine when 
deposited embraced a great range of colours; the different shades of yellow 
with more or less intermixture of red being the most common. The degree 
of its transparency also varied much. But towards the last month of ges- 
tation, the urine, with more or less uniformity, as will be seen by the tables, 
became much darker, assumed a reddish or salmon colour, and often di- 
minished in transparency. This change has been noticed by the ancient 
writers; and, although not invariable, seems to me deserving of more atten- 
tion. 

Having convinced myself, that the urine of healthy females undergoes 
during utero-gestation a change, which is indicated by a pellicle in many 
respects similar to that described by Nauche, and also that the urine of other 
states might in some rare cases require for its distinction a careful compar- 
ative scrutiny; I next sought to determine by observation, whether the kies- 
teinic pellicle occurred in other conditions. 

The well known fact that the elements of the milk have been found in 
the urine, — the opinion of some physiologists, that, separated from the blood 
and existing in the mammae, it may during gestation be reabsorbed and ex- 
creted by the kidneys, — and more immediately, the supposition of Dr. Bird, 
that the kiesteine was owing to its presence, — naturally led me to examine 
the urine during the various conditions of lactation. 

By resorting to the nursery wards of the hospital, at that time containing 
a large number of patients, and subsequently by examining all the delivered 
cases of the obstetrical wards, I was enabled to observe no less than ninety- 
four cases. These I have grouped in the table marked B. 

The results establish the fact, that the kiesteine is by no means peculiar to 
pregnancy; and they have at the same time an important bearing on cir- 
cumstances which contribute to the theory of the production of this pellicle. 

Of the ninety-four cases of females in a state of lactation, forty-two gave 
the usual urinary changes without any indication of the kiesteine; eight pre- 
sented a scum, but modified or imperfectly formed; while forty-four exhi- 
bited the perfect kiesteinic pellicle, as well developed as in ordinary cases 
of pregnancy. 

The conditions, which appeared to exert an influence over its formation or 
its absence, may be the subject of a few remarks. 

Immediately after delivery, and during the lochial discharge, when the 
urine owing to its intermixture was more or less reddened, a scum formed 
of a semi-transparent hornlike appearance, marked by arborescent figures of 
a sanguineous tinge. 

In the interval between the birth of the child and the free establishment 
and exit of the lacteal secretion, — of twenty-three cases in which I succeeded 
in preventing lochial admixture, fifteen gave a kiesteinic pellicle. 

After the more immediate sequelae of pregnancy and delivery had disap- 



1842.] Kane on Kiesteine, 23 

peared, when the secretion of the milk was perfectly established, and the 
mother had begun to suckle freely, it appeared in two cases only. 

Of the large number of cases that were examined during lactation, several 
gave the pellicle well marked, when there was no lacteal disturbance to ex- 
plain it. In these, however, the breasts were full and even turgid, indicat- 
ing an exuberant supply or inadequate withdrawal of the secretion. 

Of cases in which the flow of the milk was prevented by mechanical or 
local obstructions, as in mammary abscess, &c., eleven in number, seven 
gave the kiesteine: of those in which the secretion was interrupted or par- 
tially suspended by constitutional disturbances, eight in number, it was 
given by only three: while of ten healthy females, eight at the period of 
tveaning exhibited it perfectly well defined. 

Four of these who had presented the kiesteinic pellicle, while weaning, 
had their milk afterwards regularly withdrawn by the cupping glass and the 
mouth. After the lacteal secretion had been in this way freely re-established, 
the urine was again examined, and no pellicle appeared. Intermitting the 
use of the cupping glass, and allowing the breasts to become turgid again, 
the urine of two again presented the pellicle. 

These results, while they demonstrate that the kiesteine is not peculiar to 
iitero-gestation, indicate also its unquestionable connection with the lacteal 
secretion.* 

Its presence during pregnancy, and even after delivery, until the milk is 
freely withdrawn by the child; its very rare occurrence during uninterrupted 
lactation; its reappearance when the discharge of milk is prevented, but 
not when the corresponding secretion is arrested; and finally its return for 
the time during the process of weaning, and its occasional absence when 
that process is intermitted; all these, regarding them as the general results 
of the observations above cited, point to one probable conclusion, — that the 
kiesteine makes its appearance, whenever the lacteal secretion exists, and its 
discharge is prevented or considerably impeded. I am confirmed in this 
judgment by its perfect consistency with the theory suggested by Dr. Gold- 
ing Bird, in the Guy's Hospital Reports for April 1840. 

Having described this pellicle under its various forms and conditions, it 
may be proper to add a few words on its nature and properties. 

Dr. Golding Bird, to whose interesting observations I have before so often 
alluded, states that " none of the specimens examined by him were coagu- 
lable by heat, nitric acid, or, with but one or two exceptions, by acetic acid." 

In all the cases mentioned in my first tables, the urine w^s submitted to 
the action of nitric acid; in about forty to that of heat; and in many, it was 

* With reference to the remark in the text, I am at this time observing the urine in 
some cases of uterine tumour, and in other conditions which exercise an influence on the 
mammary secretion. 



24 Kane on Kiesteine. [J"b' 

tested with the ferro-cyanuret of potassium, after having been acidulated 
with acetic acid. 

Of those which were exposed to heat, seven presented a coagulum; but re- 
membering the precautions urged by Dr. Rees* to prevent the earthy phos- 
phates being mistaken for albumen, 1 submitted the fluid in these cases to 
other tests, and thus found that of the seven cases apparently albuminous, 
three were in reality phosphatic. Four only, of course, were to be regarded 
as containing albumen. 

Ammonia gave a deposite of varying density; and acetic acid in several 
cases caused coagulation. 

The urine, tested daily with litmus, was found in almost every instance 
to be faintly acid, up to the time of disintegration of the crust. At this pe- 
riod, however, it undergoes the ammoniacal development, and acquires 
well marked alkaline properties, which probably induce the disintegration. 

The pellicle itself, treated with alcohol, became of a fatty saponaceous 
character; the crystals remaining but little affected. Treated with ammonia, 
the granular matter was partially dissolved, and the crystals were made more 
manifest: they were even susceptible of isolation by careful washing and fil- 
tration. Acetic acid destroyed the crystals, and reduced the accompanying 
matter to a pultaceous mass, without materially altering its structure. 

In the present state of physiological chemistry, but little can be determin- 
ed with regard to the nature of the kiesteine, and its very doubtful claims 
to be considered as a new principle. The absence of coagulation by appro- 
priate agents indicates in a measure that neither caseum nor albumen exists 
in very perceptible quantities; while the acid reaction up to the moment of 
disintegration seems opposed to the idea of its being a mere attendant upon 
increased quantities of pus or mucus. 

Still, these with other as yet undetected principles may be constituents of 
the pellicle itself; and the question, whether any matters developed in it are 
identical with the caseum of the milk, must be determined by further 
observations, made perhaps in a more advanced stage of science. For, in- 
dependently of the possibility of this principle occurring without the inter- 
vention of the mammary secretion (see Andral, &;c.), Orfila himself has 
acknowledged his inability to distinguish the caseum from other organic 
matters;! and M. Dumas has announced a substance in every respect simi- 
lar to it, as one of the ingredients in the composition of pus. 

My remaining observations were microscopic. I employed for them 
during the earlier stage of my inquiries, a simple Raspail instrument, with a 
Wollaston eye-glass; but the few results which I feel justified in detailing 

* See paper on "Real and supposed pathological conditions of the urine," by G. O. 
Rees, M. D., Northern Dispensary, London. Guy's Hospital Reports, 
t Traite de Chimie, &c. 



1842.] Kane on Kiesteine. 25 

were attained by an excellent Berlin microscope, belonging to Dr. Goddard, 
and which he with great kindness assisted me in using. I can have no rea- 
son to doubt the correctness of observations made under the guidance of so 
practised an observer; but owing to the many sources of fallacy attendant 
upon microscopic evidence generally, I do not venture to claim for these the 
same confidence, which is due to my examinations by the unassisted eye. 

The pellicle, taken immediately from the urine on a glass plate, carefully 
introduced, when examined with a magnifying power of one hundred 
diameters, exhibited, while yet moist, a well defined series of flakes of a 
somewhat darkish yellow, made up apparently of minute granules. This 
appearance, which I at first thought to consist of minute globules of mucus 
or pus, was at once recognised by Dr. Goddard, as closely resembling, if 
not identical with, the granules of the colostrum. Having with some diffi- 
culty procured a supply of this fluid, a comparison of the two exhibited still 
more clearly this interesting resemblance. The granules of the kiesteine 
were however more flattened than those of the colostrum, a change they 
might readily have undergone during their passage through the kidneys; but 
the general aspect of the two was such as to give strong evidence of their 
identity.* 

Connected with these appearances, and sometimes obscuring them, the 
kiesteine presented under the microscope an irregularly disposed amorphous 
matter, sometimes arranged in groups of granules that resembled the urate 
of ammonia,! and sometimes of badly marked globules, allied to those of 
pus or mucus, and accompanied by laminee resembling epithelia.:}: 

Throughout the field of the instrument was seen, in varying numbers and 
distribution, a series of rectangular rhomboidal prisms, more or less dis- 
tinctly marked, and strongly refracting light. The triangular prisms were 
also occasionally distinguished, but not in the " myriads" seen by Dr. Bird; 
and sometimes other crystalline forms were observed in addition to these. 
They all belong most probably to some of the earthy phosphates. Not 
only were the triangular prisms recognised to be those described by Dr. 
Bird, as belonging to the ammoniacal phosphate of magnesia, but by com- 
paring them with the microscopic plates of Rayer and Vigla, and Mandl, 
(Etude Microscopique sur I'Urine,) many others were discovered, coincid- 
ing with the varied forms of this prominent salt. 

On treating the pellicle, collected as for examination, with acetic acid, 
applying a gentle heat, and then carefully washing the residuum; the crys- 
tals, as in a similar experiment by Dr. Bird, entirely disappeared, and the 
graniform masses, somewhat obscured, presented themselves al(>ne.§ By 

* This resemblance was very striking upon comparing it with the plates of M. Mandl. 
t See Mandl, Raspail, and Rayer. 

X See plates of Rayer and Vigla, Encyclographie Medicale, Vol. VI. 
§ So completely were they deprived of erystalline matter, that in a similar experiment 
by Dr. Bird, after illuminating the granular, or — as he defines it— the "opaque mass," with 

No. VII.— .July, 1842. 3 



26 Kane on Kiesteine. [July 

using ammonia, the reverse was the case. The crystals, nearly unaltered, 
remained unusually distinct; while, by the careful addition of water, the 
granular and other matter, much softened, was readily washed away, leaving 
the supposed triple phosphates remaining. 

When the pellicle has been for a short time exposed under the micro- 
scope, the natural salts of the urine are developed by evaporation, present- 
ing numerous shining crystals of varied forms; among the most prominent 
of which are the triangular and the obscurely marked hexagonal prisms. 

The cubic crystals, which M. Eguisier describes, as present in the true pel- 
licle after it becomes old, I have never seen. In a few cases of both kies- 
teinic and other pellicles, a hollow four-sided pyramid was obseived, resem- 
bling the chloride of sodium, and in one case a regularly formed cube. This 
was the nearest approach to the appearances mentioned by Eguisier. 

In the pellicle not kiesteinic, the peculiar granular arrangement noticed as 
so strongly resembling the colostrum, was in no case present. Amorphous 
darkish masses, accompanied by various crystalline forms, were seen only. 
Where much discoloration existed from sanguineous or lochial intermixture, 
a strong resemblance was observed to the globule of the blood. 

The shining appearance of the kiesteine is evidently not owing to fatty 
matter, unless under very peculiar modifications. Neither do I think it 
entirely owing to the numerous crystals of the triple phosphates, observed by 
Dr. Bird. I apprehend, that the specimens, in which he found them so abun- 
dant, may have been exposed for soma minutes to evaporation; as I have 
remarked, that under such circumstances, the proper salts of the urine de- 
velop themselves rapidly in their crystalline forms. I would rather refer 
the glossy character of the surface to the presence of animal matters gene- 
rally in the pellicle, without adducing either its fatty elements or the crystals 
on its surface as the explanation. 

It may be proper that I should close this paper by some remarks on the 
value of the kiesteine as a diagnostic of pregnancy. I do so with diffidence, 
for my opinions are not sustained by the judgment of the more experienced 
observers who have preceded me. 

I cannot regard the kiesteine as an unerriyig test of pregnancy. I have 
already shown that it is present under other conditions of the system; and 
even where pregnancy exists, I am satisfied that this indication is not always 
observable. 

I am convinced too, that the kiesteine is not always distinguishable from 
other pellicles which appear on the surface of the urine. At least, I am 
bound to say, that, in the absence of other indications, I should sometimes 
have found myself unable to distinguish between them. Not that they are 

a beam of polarised light and analysing the ray by means of tourmaline, not a trace of 
colour was perceptible. 



1842.] Kane on Kiesteine. 27 

generally liable to be confounded; but between the imperfectly developed 
pellicle of the one character, and the best simulation of it which is some- 
times presented by others, the distinction is too slight to be satisfactory or 
unfailing. 

But with the qualifications which these remarks imply, I have no doubt 
that the pellicle which has been denominated kiesteine is among the best, 
if indeed it be not the most certain, of the earlier indications of pregnancy. 
I resorted to it habitually in my diagnosis in the obstetric wards of our 
hospital, and with constantly increasing confidence. 

In one case, I felt myself at liberty to direct the removal of a patient to 
the working ward, who claimed the privileges of pregnancy in round terras, 
and presented all the other symptoms of that state in confirmation of her 
pretensions. She still retains the suspended catamenia, enlarged abdomen, 
&c., though five months have elapsed since the birth of the infant was pro- 
mised me as a proof of my mistake. Other cases of attempted imposture, 
some of them ludicrous enough, which were detected by the same means, I 
have collected in my table C. 

My associates at the hospital have not unfrequently amused themselves 
by presenting for my inspection, the urinary excretions of all sorts of pa- 
tients, and in many varieties of combination. I believe they will bear me 
witness, that my reliance on the kiesteinic test has not misled me. 

Indeed, the cases which I have referred to, and which are arranged in 
series in the accompanying tables, must satisfy an unprejudiced mind, that 
there is something well worthy of the obstetrician's study in the pellicles 
presented by the urine during utero-gestation. 

The result of my observations may be summed up in the following gene- 
ral conclusions: 

1. That the kiesteine is not peculiar to pregnancy, but may occur when- 
ever the lacteal elements are secreted without a free discharge at the mammae. 

2. That though sometimes obscurely developed and occasionally simu- 
lated by other pellicles, it is generally distinguishable from all others. 

3. That where pregnancy is possible, the exhibition of a clearly defined 
kiesteinic pellicle, is one of the least equivocal proofs of that condition; and 

4. That when this pellicle is not found in the more advanced stages of 
supposed pregnancy, the probabilities, if the female be otherwise healthy, 
are as 20 to 1 (81 to 4) that the prognosis is incorrect. 

Philadelphia, January 28, 1842, 



28 



Kane on Kiesteine, 



[July 







(A) — Table of Cases during Utero- Gestation. 






Names. 


■u 




Condition of 
Mammae. 


Appearance when 
received. 


Remarks. 


Result. 


1 






UbI 










1 


M. Biddee, 


24 


H 


Milk exuding 


Salmon yellow, 


Surface gave a filmy pel- 


Kiest. 










upon pressure. 


turbid, flocculent, 


licle in 16 hours, preceded 


on 3d 










Mammae much 


and with no depo- 


by crystals. No well 


day. 










distended. 


sits 


marked cloud or deposite. 




2 


S. Gilbert, 


20 


88 


Milk in mammae Deep reddish yel- 
fromthe seventh low. Turbid, and 


Crystalline dots. A firm 
cream-coloured pellicle 


K. on 4th 
day. 










month. 


with some deposi- 
tion. 


on 4th day, covered with 
nutmeg like specks. 




3 


M. Hill, 


32 


7. 


No milk. 


Transparent, with 
a deep tinge of red. 
No mucous flocculi. 


The shining specks pre- 
ceding the formation of the 
pellicle which occurred 
on the 2nd day. No cloud. 


K. on 2d 

day. 


4 


E. Williams, 


25 


8. 


Milk from this 


Turbid honey yel- 


Surface covered with striae 


K. on 3d 










time. 


low, with little or 
no deposite. 


of a deep yellow, a firm 
pellicle filling up the in- 
terstices. Odour cheesy. 


day- 
cheesy. 




(( u 


(( 


9. 


(( (( 


Dirty red,with some 
deposition. 


Sides of glass coated by 
deposition. Distinct pel- 
licle on fourth day. 


K. on 4th 
day. 


5 


S. Dunken, 


17 


9. 


Milk exuding by 


Pale glaring white 


Pellicle in circles, greasy 


K. on 










pressure. 


flocculi. 


in appearance, and not 

well defined until the 5th 

day. 

Little pellicular change 

until 4th day; it then gave 


5th day." 


6 


A. Lippincott, 


36 


8.12 


No milk. 


Salmon yellow, 


K. on 












much deposite. 


7th day. 














a perfect pellicle about 
















the 7th. 




7 


A. Banks, 


37 


8.20 


Milk by cupping 


Salmon colour with 


A good type of the pelli- 


K. on 3d 










glass. 


deposition. 


cular appearance. Not 
perfect until the 4th day. 


day. 


8 


H. Walker, 


24 


7. 


Milk a few days 


Turbid, flocculent, 


A well marked opaline 


K. on 3d 










previous. 


and with a copious 
deposite. 


cloud, above which the 
pellicle, much modified, 
appeared. 


modified 


9 


M. Yacely, 


24 


8.13 


No milk, but ve- 


Turbid salmon co- 


Stood for 12 days without 


^1 
1 K. 










ry turgid. 


lour, but very scan- 


any pellicular change. 












ty. 






(( (( 


u 


6. 


No milk. 


Lighter, and nearly 


Stood until putrefaction 












transparent. 


took place without any 
pellicular manifestations. 


^\ 


10 


M. Gallagher, 


39 


During 


No milk. 


Reddish yellow. 


Pellicle not continuous. 


K. on 3d 








labour. 




with much floccu- 
1-ent deposition. 


and wanting the tenacious 
character of the kiesteine. 


modified 


11 


M. Delano, 


20 


8.11 


Milk from the 


Straw yellow, 


Decided pellicle on the 


K. on 2d 










6th month. 


bright and transpa- 
rent. 
Muddy reddish yel- 


2nd day. 


day. 


12 


E. Buckley, 


40 


Day of 


Milk by pressure 


An irregular striated pel- 


Excep. 








deliv. 




low, and no depo- 
site. 


licle; no crystals, and not 
such as to warrant me in 
pronouncing it kiesteine. 
Regularly formed pellicle 


tion. No 
K. 


13 


M. Yorkley, 


20 


8. 


Milk. 


Pale yellow, nearly 


K. on 3d 












transparent. 


— thin and pale; odour 

cheesy. 

Spider like lines and cir- 


cheesy. 


14 


S. Miller, 


20 


7.6 


Milk in breast at 


Reddish yellow, 


K. on 2d 










the 7th month— 


nearly transparent. 


cles, yet a well defined 


day. 










none at present. 




pellicle. 

Pellicle characteristic. 




15 


C. Ryter, 


17 


9th 


None. 


Bright straw yellow 


K. on 3d 












- no deposite. 




day. 


16 


B. M'Gurth, 


21 


9th 


Small and flac- 


Yellow tinged with 


Pellicle not over the en- 


K on 1st 










cid mammae. 


red, and very tur- 
bid. 


tire surface; decomposi- 
tion rapidly set in. 


day mo- 
dified. 


17 


A. Weaver, 


21 


7. 


Copious exuda 


Turbid red, with a 


An obscured pellicle on 


Doubtful 










tion of milk. 


deposite coatine; 
sides of glass. 


2nd day; not well defined. 


K. on 2d 
day. 




(( (( 


a 


8. 


(( (( 


Not so much depo- 
sition. 


A characteristic pellicle 
on the 3d day. 


K. on 3d 

day. 


18 


R. Dawson, 


22 


Day of 


No milk. 


Muddy red, with 


The urine was of a dark 


K. on 5th 








deliv. 




much deposite. 


brown at the surface: on 
the 2d day this disappear- 
ed, and on the 4th a well 
marked pellicle appear'd. 


day. 


19 


C. Scoby, 


24 


during 


Milk at the 7th 


Bright ruby, red 


Pellicle very thin and 


NoK. 








labour. 


month. 


tinge with much 
transparency. 


filmy, the crystals very 
numerous. 





1842.] 



Kane on Kiesteine. 



29 



Table (A) continued. 





Names. 


B'm 


geof 
ignancy 
months 
i days. 


Condition of 
Mammee. 


Appearance when 
received. 


Remarks. 


Result. 


6 






l£.ai 










C. Scoby, 


24 


4.20 


No milk. 


Lighter and not so 


Pellicle, although not ve- 


K. on 4th 












transparent. 


ry well marked^still kies- 
teinic 


modified 


20 


H. Benal, 


24 


During 


None. 


Pale whitish yel- 


Surface covered with a 


K. on 1st 








labour. 




low, translucent. 


cloudy pellicle from 36 day 

hours after deposite; odour cheesy, 

cheesy. 

Labouring under much fe- K. on 4th 




U IC 


(( 


7. 


(( a 


Very turbid, and 












tinged with red. 


brile disturbance : pelli- day, 
cle, though not well mark- 
ed, is still present: not 
cheesy. 


21 


E. Hull, 


20 


^ 


No milk. 


Straw yellow- 
transparent. 


Mouldy dots on surface; K. on 4th 
pellicle forming around day 














them. Very damp wea- 
ther. 


cheesy. 




u « 


(( 


7th 


u a 


Bright straw yel- 
low, with a few floc- 
culi. 


Pellicle advancing regu- 
larly from 2nd day. 


K. on 4th 

day 

cheesy. 


22 


M. Robinson, 


19 


9. 


No milk. 


Purulent or mucoid 
very turbid yellow. 


Gave no acid reaction K on' 3d 
with the litmus. Pellicle day. 
very flat. 


23 


M. Robinson, 
white vene- 
real ward. 


a 


6th 


a a 


Light straw yellow; 
transparent. 


Gave a well marked de- K. on4lh 
cided pellicle, preceded day. 
by crystals, and covered 
with brown nutmeg dots. 


24 


C. Clarke, 


30 


5th 


Milk by pressure 
from one mamma 


Bright red; nearly 
transparent. 


Gradual and characteris- K. on 3d 
tic. day. 


25 


A. M'Hugh, 


26 


7. 


Milk in breasts 
since 5th month. 


Pale light translu- 
cent yellow. 


Kiest. well marked, but! K. on 2d 
not in a uniform stratum, day. 


26 


M. Curio w, 


22 


8. 


Milk since 7th 
month. 


Turbid red. 


The pellicle forming with K. on 2d 
great regularity; moulding day. 
on 3d day, owing to damp. 


27 


M. Rider, 




6, 


No milk at pre- 


Turbid red: many 


Decomposition after sian-' t^jl 
ding8days. Extreme an- Ji INo 
semia. Alkaline reaction. kS (K. 
Same result. |S-j 










sent. 


flocculi. 
















u u 


a 




a u 


Not so turbid. 


28 


A. Clarke, 




8. 


Milk by pressure 


Deep salmon colour 
—some deposition. 


Stood for 3 days without'K.on8th 
any change: it then exhi-;day. 














biied the crystals and a 
















gradual characteristic pel- 
















licle, well formed by 8th 
















day. 




29 


M. Ackland, 




7. 


Milk at present 


Straw yellow ting'd 


Stood for some time with- 


K. on 4th 












with red. 


out change. A pellicle on 'day. 
4th day. 1 


30 


E. Johnson, 




6. 


No milk. 


Yellow honied, 
translucent. 


A modified irregular pel- K on 3d 
licle. modified 


31 


J. Garrigan, 




5. 


No milk. 


Salmon colour, tur- 
bid, and with depo- 


A singular tenacious scum K. on 3d 
two lines in thickness and modified 












sitions. 


of a deep blue colour. 




32 


S. Dashur, 


30 


During 


Milk from last 


Deep red, translu- 


A well developed pelli- 


K. on 4th 




women's out 




labour. 


pregnancy, 18 


cent. 


cle. 


day. 




wards. 






months previous. 








33 


L. Hauwick, 


25 


6.25 


Milk one week 


Straw yellow — 


Decomposed rapidly— a 


K on 2d 










afterquickening. 


transparent. 


very copious deposite and day. 
tolerably marked pellicle 
were observed. 


34 


M. Stratton, 


30 


9. 


No enlargement 
and no milk. 


Straw yellow, with 
flaky masses. 


No very evident crystals. K. on 5th 
day. 


35 


M. A. Bowers, 


23 


7.14 


Milk at and du- 
ring last month. 


Red, with lateri- 
tious deposite. 


No pellicle whatsoever K. on 3d 
until 3d day. jday. 


36 


M. B. Mark. 


18 


7.19 


Milk from her 8th 
month. 


Reddish yellow— 
no deposition. 


The cloud like appear- .K. on 4th 
ance preceded the charac- day. 
teristic pellicle. 


37 


E. Wilkinson, 
or Atkinson, 


41 


9. 


No milk. 


Purulent yellow, 
with copious depo- 
site. 


Litmus gave no acid reac- Excep- 
tionr fefrocyanuret oiT^o-tion. 
tassium and heat gave No K. 
coagulation. 


38 


M. Stevens, 


34 


8.20 


Milk by pressure 


White glaring and 
pale. 


A very thin buthighly cha-l K. on 1st 
racteristic pellicle, with day 
cheesy odour. j cheesy. 


39 


M. Sailers, 


29 


9. 


Milk by pressure 


Reddish yellow. 


A thick pellicle, not pre- K. on 4th 
ceded by crystals. day. 



30 



Kane on Kiesteine, 



[July 



Table (A) continued* 





Names. 


i^ 


age of 
egnancy 
months 
id days. 


Condition of 
Mammae. 


Appearance when 
received. 


Remarks. 


Result. 


40 




^^ 


cc^as 










M. Hero, 


15 


6.16 


Distended and 


Reddish yellow, 


Presented for the two first 


K. on 3d 










exuding milk. 


translucent with 
flocculi. 


days the acicular crystal- 
line specks; on the third 
day the pellicle, and on 
the fifth well marked nut- 
meg like spots. 


day. 




(( (( 


15 


9. 


(( (( 


More turbid; colour 
very nearly the 
same. 


Crystals, creamy pellicle, 
&c. at their greatest deve- 
lopment on 5th day. 


K. on 2d 

day. 


41 


A. M'Cully, 


22 


7.14 


Large and exud- 


Pale straw colour, 


Surface marbled on 2nd 


K. on 6th 










ing the mi!k. 


rather dim, yet 
transparent. 


day; crystals also evident; 
pellicle on 3d: by 6th day 
well marked. 


day. 


42 


S. Palmer, 


19 


6. 


No milk. 


Dim, transparent. 


A horn like or waxen pel- 


K. on 4th 












honied yellow. 


licle, crystalline _pom^s day mo- | 














interspersed. 


dified. 




u a 


(( 


During 


Abundantsupply 


Red, highly colour 


Urine highly coloured- 


NoK. 








labour. 


of milk. 


ed, with lateritious 
deposite. 


presented a horny pellicle 
with white striae intersect- 
ing it. 
Minute crystals on the 1st 




43 


B. Devine, 


20 


5.27 


Milk. 


Salmon colour. 


K.on4ih 














day; surface studded on day. 














2d; cloudy appearance on 














3d; pellicle on 4lh. 

Uniform scum; crystals K on 3d 


44 


M. M'Guire, 


23 


8. 


No milk. 


Bright straw yel- 












low, clear. 


not very evident, day. 




(( K 




2 days 


Very tense, but Garnet colour, with 


Athickconsistentpellicle|K. on 2d 








previous 


no exudation of a few flocculi. 


formed on 2nd day, slight- day. 










milk. 




ly tinged with red, one 
line in thickness. 




45 


E. Hastley, 


36 4mos. 


Distended. 


Translucent, red, 
with some deposi- 
tion. 
Clear cider yellow; 


A characteristic ^creamy' 
pellicle. 


K. on 4th 
day. 


46 


A. Hutchins, 


19 4mos. 


Mammary ab- 


A cloud on the 2nd day. 


K. on 3d 










scess, with fistu- some deposite. 


preceded by crystals, and day. | 










lous orifices. 




followed by a pellicle with 
brown dots. 




47 


A. Graves, 


25 6mos. 


Distended. 


Brownish ochre 


Does not redden litmus pa-'Excep- 












yellow, with much 


per: decomposition com-Hion. 












deposite. 


mencedon2ndday: gives No K. 














no pellicle. 




48 


H. Thompson, 


20 6mos. 


Tumid, but no Slight muddy yel 


Presented no pellicle 


1 










milk. 


low; quantity 20 oz. 


whatever: found on inqui- 
ry that it was voided in 
the afternoon. 


,K. on 
f 3d day 




(( (( 


a 


9. 


(( (I 


Straw yellow, mud- 
dy. 


Presented a well marked 
pellicle on the 3d day 
Little change until 4th 


J 


49 


J. M'Cartney, 


39 


8.10 


Turgid, but ex- 


Greenish or citrine 


K on 5th 










uding milk. 


yellow. 


da,y: pellicle perfect on 


day. 




(C t( 


11 




(( « 


Clear cider yellow. 


Pellicle apparent on 2nd K. on 2d 
day: at its maximum on day 














7lh: odour cheesy. 


cheesy. 


50 


S. Fisher. . 


24 


7.20 


Milk. 


Clear cider yellow, 
trans. 


Milky, opaline or white 
pellicle on 3d day. 
iPellicle on 3d day; odour 


K on 3d 
day. 


51 


A. Lenam, 


40 


8.20 


No milk, but Xight reddish, cider 


K. on 3d 










tense. 


yellow, flocculent. 


cheesy, but very slightly 

so. 

Pellicle on 3d day, soon 


day. 


52 


M. Gilbert, 


24 


6.25 


No milk. 


Reddish yellow and 


K. on 3d 












no deposite. 


obscured by decomposi- 
tion. 
Well marked on 2nd day 


day. 




u <e 


(( 




(( (( 


Deep red, with floc- 


K on2d 












culi. 


with crystals, specks and 


day. 




_ 










fat like appearance. 




53 


M. M'Mename 


20 


7.21 


Left mamma ex-jLight cider yellow. 


Peculiar pellicle arranged 


II No 
1 fK. 










udes milk: ab- 




in striae and in circles— 










scess in right. 




not the kiesteine. 




« u 


« 






Rather dusky. 


Same result. 


^J 


54 


C. Smith, 


23 


7. 


Milk. 


Bright straw yel- 
low. 


Pellicle regularly formed 
on 2nd day; cheesy on 5th. 


K. on 2d 

cheesy. 


65 


M. Moody, 


23 


8.16 


Milk since her 


Reddish yellow. 


A well marked pellicle 


K. on 3d 










3d month. 


somewhat brown. 


studded with crystals. 


day 




(( « 






(( (( 


Same with flocculi. 


Voided a few hours before 
delivery: decomposed ra- 
pidly but the pellicle well 
marked. 


K.on2d 
day. , 



1842.] 



Kane on Kiesteine. 



31 



Table (A) continued. 





Names. 


S m 


Stage of 
Pregnancy 
in months 
and days. 


Condition of 
Mammee. 


Appearance when 
received. 


Remark. 


Result, 


i 




tl 










56 


M. Schuyler, 


29 


Day of 


Week before de- 


Honey yellow, ra- 


Decomposition about the 


Modi. 








delivery 


livery had milk 
in mammae. 


ther turbid. 


3d day: pellicle ramiform 
and not regularly disposed 


fiedK. 




(( « 






(( u 


Same, rather more 
transparent. 


No pellicle until 4th day, 
and then very feebly de 
veloped. 


K. on 4th 
day. 


57 


H. Charles, 


30 


9. 


Milk since 7th 


Reddish yellow, 


Pellicle formed regularly 


K. on 2d 










month. 


some deposite. 


from 2nd day. 


day. 


m 


M. Parker, 


20 


8 days 


No milk, but 


Transparent, gar- 


Pellicle in circles incrust- 


K. on 3d 








previous 


much distended. 


net colour. 


ing sides of glass. 


day mo- 
dified. 








.0 deliv. 








59 


M. Milnor, 


30 


7.28 


Milk upon pres- 


Clear straw yellow; 


Milky, dotted and charac- 


K.on4lh 










sure. 


no deposite. 


teristic pellicle— cheesy. 


day. 


GO 


M. Collins, 


20 


6. 


U (( 


Abundant lateri- 
tious deposite. 


Striated, glazed, unsatis- 
factory pellicle. 


K. on 5th 
modified 


61 


E. Connor, 


20 


7.10 


Milk in mammae 


Palish water yel- 


Minute doited pellicle, 


K. on 3d 










from 3d month. 


low; muddy. 


kiesteinic but very thin. 


day. 


62 


A. Petsai, 


30 


6 


No milk. 


Deep red, with floc- 
culi. 


Characteristic. 


K. on 5th 
day. 


63 


A. Mason, 




7. 


No milk. 


Light reddish. 


The brownish nutmeg 
specks. 


K. on 3d 
day. 


64 


H. Conway, 




61 


No milk. 


Transparent bright 
ruby red. 


Regularly formed; stood 
14 days without disinte- 
grating _ 
In circles, havmg a corru- 


K. on 2d 

day. 


65 


E. Hutten, 




5. 


Milk exuded in 


Transparent red, as 


K. on 3d 










3d month. 


above. 


gated aspect. 


day. 


66 


H. Anderson, 


18 


7. 


No milk. 


Flocculent red. 


Not uniformly disposed. 


K on 3d 
modified 




« (( 


u 


7| 


Milk. 


(( u 


A well marked pellicle on 
3d day. 


K. on 3d 

day. 


67 


E. Jeansire, 


20 


6| 


Milk a week pre- 


Bright straw yel- 


Opalescent regularly 


K. on 3d 










viously. 


low. 


formed pellicle. 

A well defined cloudy de- 


day. 


68 


M. Miller,* 


32 


3 trials of 


Trifling altera- 


Flocculent red. 


NoK. 








2 weeks, 


tions. 




posite, but no kiesteinic 










7 weeks, 






pellicle. 










& 3 mos 










69 


Mrs. C. G-m, 


35 


Full 21 


Full and turgid. 


Cider yellow; very 
flocculent 
Straw yellow. 


Gave a well marked K. 


K. 


70 


Miss Baker, 


21 


10th 


No changes in 


Accompanied by the 


K. on 3d 








week. 


conformation. 




brownish specks. 


day. 


71 


E. Black, 


161 


6 weeks. 


Enlarged slight- 


Bright honey yel- 


A well formed kiesteinic 


K. on 2d 










ly ; no marked 


low. 


pellicle on 2nd day. • 


day. 










characteristics. 








72 


M. Alexander, 


36 


8 mos. 


Milk by syringe. 


Flocculent. 


A well marked pellicle 
preceded by the crystals 
and sediment. 


K. on 3d 
day. 


73 


M. A. Cornell, 


22 


7 mos. 


Milk. 


(( 


Kiesteine with great te- 
nacity on 4th day. 


K. on 4th 
day. 


74 


M. M'Canny, 


19 


6 mos. 


Turgid and with 
milk. 


Turbid straw colour 


Well marked kiesteine— 
alkaline with litmus. 


K. on 2d 
day. 


75 


S. Sharp, 


25 


5. 


No milk. 


Very viscid. 


But a well marked pel- 
licle. 


K. on 2d 
day. 


76 


M. Richardson, 


21 


8. 


No milk. 


Obscured dark red. 


Bronchitis, urine alkaline 
and no pellicle 


NoK. 




« C( 


" 


(( 


Milk. 


Lighter colour and 


Gave a modified pellicle. 


Mod. K. 


77 


A. Thompson, 


30 


9. 


Milk. 


transparent. 
Ruby red 


Well marked pellicle. 


K.on3d. 


78 


S. Spangler, 


26 


8. 


Turgid and exud- 
ing milk. 


Flocculent. 


Firm consistent pellicle. 


K. on 3d 
day. 


79 


S. Carey, 


23 


5. 


Milk. 


Honey yellow. 


Well marked kiesteine. 


K. on 4th 


80 


M.A.Andrews, 


22 


7. 


Milk. 


Turbid. 


K. on 3d; no deposition 
evident to the eye. 


K. on 3d 

day. 


81 


S. Ford, 


28 


9. 


No milk. 


Highly coloured- 
ruby tinge. 


K. on 5th. 


K. on 5th 
day. 


82 


M. A. O'Neill, 


25 


7. 


Turgid with m'k. 


Flocculent. 


Well marked pellicle 
with cheesy odour. 


K. on 4th 
cheesy. 


83 


J. Scantlen, 


22 


7. 


Milk. 


Muddy straw colour 


Somewhat striated, yet a 
characteristic scum. 


K. on 1st 
day. 


84 


E. Dougherty, 


27 


a 


Milk. 


Reddish do. 


Consistent pellicle. 


K.on2d. 


85 


M. Thompson, 


32 


3. 


Milk. 


Clear straw colour. 


Modified by striae. 


Mod. K. 



* Found after these results were in type not to be pregnant. 



32 



Kane on Kiesteine. 



[July 



(B) — Cases during Lactation, 



1 


Names. 


Age. 


Time after 
Delivery. 


Condition of Mammae 


Remarks. 


Result. 


S. Miller, 1 


20 


2 months. 


Freely withdrawn. 


No pellicle. 


NoK. 


2 C. Ryter, 


17 


2 weeks. 


u u 


li u 


No K. 


3 B. M'Gurth, 


21 


6 weeks. 


(( u 


i( « 


No K. 


4 A. Weaver, 


21 


8 hours. 


Rather turgid, but ex- 


Before establishment of the 


No K. 










uding milk. 


lacteal secretion on the ap- 
plication of the child to the 
breast. 
















5,R. Dawson, 


22 


2 weeks. 


Freely suckling. 


No pellicle whatsoever. 


No K. 


<( (f 


" 


3 months. 


u u 


No change. 


No K. 


e'c. Scoby, 


24 1 week. | 


H 11 


No change 


No K. 


7|H. Benel, 


24 


72 hours. 


Milk not yet with- 
drawn. 


Immediately afterbirth gave 
a red horn like pellicle. 


No K. 


8 E. Hull, 


20 


4 days. 


Freely suckling. 


No change. 


NoK. 


9 M. Robinson, 


19 


Iday. 


Large, tumid, and but 
little milk. 


One day after birth of a still- 
born child rather sanguine- 


K. on 4th day. 


10 C. Clarke, 


30 


2 months. 


Withdrawn freely. 


ous. 

No change by pellicle. 


No K. 


11 


A. M'Hugh, 


26 


1 month. 


It u 


(( u u 


No K. 


12 


M. Curlew, 


22 


3 weeks. 


(( u 


(( (( u 


No K. 


13 


M. Ryder, 




1 month. 


(( u 


(( (( li 


No K. 


14 


A. Clarke, 




1 or 2 months 


Mammae large and 
secretion scanty. 


Secretion much disturbed 
from a gastro-enteritic at- 
tack. 
No pellicle resembling K. 


No K. 


15 


M. Aiklyn, 




4 months. 


Freely withdrawn. 


No K. 


16 


E. Johnson, 




6 months. 


(( K 


" " 


No K. 


17 


J. Garrigan, 




3 weeks. 


Much inflamed and 
swollen. 


Inflammationof the papillae 
—gave a well defined pelli- 
cle on 4th. 


K. on 3d day. 


18 


S. Dashur, 




18 months. 


No exit to milk. 


While weaning on 3d day. 


NoK. 


19 


L. Hawick, 




3 months. 


Freely emptied. 


Milk plentiful and regular- 
ly withdrawn. 


NoK. 


20 


M. A. Straton, 




2 months. 


Painful, and no milk 
visible. 


Severe bronchitis; secretion 
much impeded. 


K. on 3d day 
cheesy. 


21 


M. Bowers, 




4 weeks. 


Milk freely withdr'n. 


No change. 


NoK. 


22 


M. Mark, 




2 months. 




Pellicle on 4th day. 


K. 


23 


E. Wilson, 




il u 


IC « « 


No pellicular change. 


NoK. 


24 


M. Stevens, 




3 months. 


No milk. 


Gastritis; no pellicle. 


NoK. 


25 


M. Salters, 




4 months. 


(( (( a 


No pellicle. 


NoK. 


26 


M. Hero, 


15 


3 days. 


Large and distended; 
no exudation. 


4 days after birth gave a red 
horny pellicle. 


NoK. 




(( a 


(( 


(( « 


Milk scanty and bad- 
ly withdrawn. 


A febrile attack (gastritic) 
gave a modified pellicle. 
Free discharge, &c. 


K. modified. 




u a 


(( 


a 11 


Freely emptied. 


No K. 


27 


A. M'Cully, 


22 


3 hours. 


Large, and no exuda- 
tion. 


Carefully withdrawn before 
secretion was well establ'd. 


K. on 4th day. 




<( (( 


(( 


3 months. 


a (( 


" " but no K. 


NoK. 


28 


S. Palmer, 


19 


4 days. 


Large, and badly 
emptied. 


During lochia a horny scum. 


NoK. 




u a 




3 months. 


Freely emptied. 


Freely nursing. 


Cheesy K. 


29 


B. Devine, 


20 


3 weeks. 


Turgid, full, and no 
exudation. 


Had not had her breasts well 
emptied for 48 hours 


K. on 4th day. 


30 


P. Bunting, 




4 weeks. 


Red, indurated, and 
no egress to secretion. 


Much distension, and com- 
mencing mammary abscess. 


K. on 3d day. 


31 


M. Biddee, 


24 


6 hours. 


Natural, and exuding 
milk. 


6 hours after delivery yield- 
ed a true pellicle. 


K. 


32 


S. Gilbert, 


20 i4 weeks. 


Freely emptied. 


No pellicle. 


NoK. 


33 


M. Hull, 


32 j3 weeks. 


a u 


a i< 


No K. 


34 


E.Williams, 


25 i Not known. 


u « 


(( (( 


No K 


35 


M. Shrook, 


22 


13 m. wean- 


Large, full and pain- 
ful. 


Weaning her child 3d day. 


K. on 3d day. 


36 


Mrs.C.C.C. 




ing. 
Weaning. 


" « 2d day. 


K. on 4th day. 


37 


C. Saxon, 


28 


8 hours. 


Bieast turgid. 


Immediately after birth gave 
a red horn like pellicle. 






a u 




Weaning. 


Natural, not very full. 


While weaning 3d day. 


No K. 


38 


H. Black, 


22 


3 months 


Milk tolerably well ! Tumefaction and inflamma- 


Modified K . 










withdrawn. 


ti on of mammae. A partial 
scum was presented. 




39 


S. Compes, 


19 


8 hours. 


Turgid. 


Interval between com- 
mencement of free secretion 
and delivery. 


No K. 




" " 


(( 


3 weeks. 


Scanty milk. 


Acute colitis with its accom- 
panying fever. 
Breasts freely discharged. 


NoK. 




u « 


(( 


4 months. 


Freely withdrawn. 


NoK. 


40 


M. O'Neil, 


25 


3 months. 


u u 


11 U li 


No K. 


41 


M. Spillrine, 


20 


2 months. 


(( a 


11 11 a 


No K. 


43. 


M M'Closky, 


23 


i6 months. 


ii (( 


11 li (1 


NoK. 



1842.] 



Kane on Kiesteine. 



33 



Table (B) continued. 



43 


Names. 


Age 


Time after 
Delivery. 


Condition of Mammae 


Remarks. 


Result. 


E.Wilkinson, 


41 


Weaning. 


Tense and full. 


2d day of weaning period. 


K. on 3d day. 


44 


E.Pugh, 




2 months. 


One mamma tumid, 
and no exit to milk. 


Injured by teeth of child. 


K. on 2d day. 


45 


M. Martha, 


22 


4 days. 


Natural. 


Free exit and well secreted; 
presented no pellicle. 


NoK. 


46 


M. Reilly, 


20 


48 hours. 


Mammae distended. 


Withdrawn by catheter 48 
hours after delivery. 


K. on 2d day. 


47 


M. M'Carty, 


39 


3 weeks. 


Freely withdrawn. 


No change. 


No K. 


48 


S. Duncan, 


17 


3 months. 


U ii 


a ii 


No K. 


49 


A. Lippincott, 


36 


3 weeks. 


Breast rather turgid. 


Bronchitis with angina; 
much lacteal secretion, but 
exit impeded. 


K. on 3d day. 


50 


A. Banks, 


37 


1 month. 


a li a 


No pellicular chanee. 


No K. 


51 


H. Walker, 


24 


8 hours. 


Large, protrudiifg and 
no milk. 


Secretion not re-establ ished; 
voided with care yet no K. 


No K. 


52 


M. Yaseley, 


24 


48 hours. 


(( a a 


48 hours after— milk not yet 
withdrawn. 


K. on 3d day. 


53 


M. Gallagher, 


39 


3 days. 


Milk freely secreted 
and withd'n by child. 


No Kiesteine. 


No K. 


54 


M. Delano, 


20 


5 days. 


a a ■' a 


(( (( 


No K. 


55 


E. Buckly, 


40 


7 days. 


a a a 


(( a 


No K. 


56 


M. Yorkley, 


20 


10 days. 


a a a 


li a 


No K. 


57 


M. M'Guire, 


23 


48 hours. 


Large, tumid and 
painful. 


Tested 36 hours after death 
of child— gave a well mark- 
ed pellicle. 


K. on 4th day 

cheesy. 




(( a 


<( 


1 week. 


Same; less distended. 


1 week after delivery breast 
much distended; child still- 
born. 


NoK. 


58 


E. Hastley, 


36 


3 weeks. 


Entire suspension of 
the lacteal secretion. 


Inflammation of mammary 
glands and entire suspen- 
sion of secretion. 


K. on 3d day. 


59 


Mrs. Ann Hatch- 
ings, 


19 


4 days. 


7 fistulous sinus. 


Peritonitis and mammary 
abscess. 


K. on 2d day. 




«( "^ ' » 




1 month. 


Induration and one or 
two closed. 


Large abscesses with 7' si- 
nous orifices ; secretion 
much impeded. 


K. on 2d day. 




(( (( 


(I 


3 months. 


Partially restored. 


Same condition; secretion 

restored. 

Immediately after delivery 

mammary inflammation & 


NoK. 


60 


A. Graves, 


25 


24 hours. 


Commencing ulcera- 


NoK. 










tion and no exit of 












milk. 


induration. 






it K 


« 


Weaning. 


a li 


While weaning. 


No K. 


61 


H. Thompson, 


26 


2 weeks. 


Freely secreting and 
well withdrawn. 


Gave a well defined kiestei- 
nic pellicle, rather reddish. 


K. on 4th day. 


62 


J. M'Cartney, 


39 


4 weeks. 


Flaccid and not se- 
creting. 


General anaemia; secretion 
much retarded. 


No K. 


63 


S. Fisher, 


24 


1 month. 


Freely emptied. 


No pellicle. 


No K. 


64 


A. Lenam, 


40 


Not known. 


Distended. 


After death of child. 


K. 


65 


M. Gilbert, 


24 


10 hours. 


" 


Between establishment of 
the secretion and birth. 


No K. 




(( ii 


(C 


3 months. 


N"atural. 


Free exit, &c. 


No K. 


66 


M. M'Mename, 


20 


4 hours. 


Not exuding. 


Immediately after birth 
carefully withdrawn. 


K. on 2d day. 


67 


C. Smith, 


23 


2 months. 


Natural 


Gave no pellicle. 




68 


M. Moody, 




2d month. 


Tumid, large, and 
suspended secretion. 


Commencing mammary ab- 
scess; gave a well defined K. 


K. 




11 IC 




3d month. 


Natural. 


Free exit. 


No K. 


69 


M. Schuyler, 


29' 


36 hours. 


Natural. 


Dropped her child while on 
the urinal— 36 hours after. 
Natural, &c. No pellicle. 


No K. 


70 


H. Charles, 


30 


10 days. 


Freely exuding and 
withdrawn. 


No change until 3d day, 
when a well marked pelli- 
cle appeared. 


K. on 4th day. 


71 


M. Parker, 


20 


5 months. 


Freely withdrawn. 


No change. 


No K. 


72 


M. Milnor, 


30 


2 months. 


a a 


" " indicative of ki- 
esteine. 


No K. 


73 


M. Collins, 


20 


1 month. 


ii a 


No kiesteinic change. 


No K. 


74 


E. Connor, 


20 


10 days. 


(( a 


Lochia continue; a reddish 
pellicle' was presented. 
Presented no change 


No K. 




(I (I 


(( 


2 months. 


li a 


NoK. 


75 


A Petsan, 


30 


20 days. 


Large, tumid, and not 
secreting. 


Inflammation and tumefac- No K. 
tion of mammae. 1 


76 


A. Mason, 


22 


1 month. 


Suspended secretion. 


Peritoneal inflammation. !No K. 


77 


H. Conway, 


19 


15 days. 


Some exudation of Mammary abscess: gave a K. on 3d day. | 










milk. well defined kiesteinic pel- 
licle. 
Breasts freely empt'd.j No kiesteinic change. 




78 


E. Hutton, 


20 


1 week. 


NoK. 



34 



Kane on Kiesteine, 



[July 



Table (B) continued. 



79 


Names. 


Age. 


Time after 
Delivery. 


Condition of Mammae- 


Remarks. 


Result. 


H. Anderson, 


19 


5 days. 


Breasts tumid, large 


Child lived 2 days: a well K. on 5th day. 










and tense. 


defined pellicle 5 days afteri 
birth. 1 
During interval of birth and No K. 


m 


E. Jeansire, 


20 


10 hours. 


Not exuding. 












free exit. 




a (I 




1 month. 


Well withdrawn. 


Fully and freely discharged No K. 


R1 


J. Mills, 


24 


4 hours. 


Large, yet exud. m'k. 


During interval no milk. No K. 








Weaning. 


^u u 


While v/eaning. ;No K. 


R2 


H. Minor, 


36 hours. 


Tense and no milk. 


By catheter, during interval. K. 


83 


C. Baker, 


20 10 hours. 


Tense, yet exuding. 


During interval between ap-'No K. 












plication of child and birth. 




84 


H Willomeine, 


22 


Weaning. 


Full and turgid. 


While weaning gave a mo- 
dified pellicle. 


K. on 3d day 
modified. 


85 


C. Van Arsdale, 


22 2 years. 


Varying. * 


Restored by glass: no kies- 
teine while weaning. 


No K. and K. 


86 


C. Cunningham, 


27 : 18 months. 


« 


While weaning restored by 
cupping glass. 


K. on 1st day. 


87 


Wilhermeine, 


22 After death 
lof child. 


(( 


Secretion restored: gave no 
liiestine. 


NoK. 




(( (( 


IS months. 


Full and turgid. 


Gave a well marked K. 


K. on 3d day. 


88 


S. Ford, 


28 3 days. 


Full and turgid. 


Puerperal peritonitis. 


NoK. 


89 


J. Scantlin, 


22 36 hours. 


Flaccid. 


ii li 


NoK. 


90 


E. Andrews, 


18 4 days after 
d'th of child. 


Large and distended. 


Pellicle well marked. 


K. on 2d day. 


91 


S. Sharpe, 


25 4 days after 
delivery. 


Large. 


No marked pellicle. 


NoK. 


92 


E. Dougherty, 


27 10 days. 


Flaccid. 


Puerperal peritonitis. 


NoK. 


93 


J. Wilson, 


25 2 months. 


Freely suckling. 


No pellicle. 


No K. 


94 


Mrs. Dickenson, 


20 3 months. 


Freely withdrawn. 


No scum nor deposits. No K. ] 



Summary of Besults in Table B. 



Condition of Patient. 


Number 
Examined. 


Result. 


Obstructions^ mechanical and otherwise, to the free exit of the 

secretion, 

Suspension and obstructions from constitutional disturbances, 
Interval between birth and the free exit of the milk, 
During vs^eaning, in various conditions of the lacteal function. 
Lactation suddenly interrupted by death of child, - 
During unimpeded and natural lactation, ... 

Total number during lactation in various conditions, 


11 

8 
13 
10 

4 

48 


7 gave the K. 
3 gave the K. 
6 gave the K. 

8 g-ave the K. 
3 gave the K. 
5 gave the K. 


94 


32 



(C) — Exainples of Cases tested hy the Kiesteinic Indication. 

1. Helen Anderson, sstat. 18, woman's venereal ward, was under treatment for 
commencing secondary symptoms, attended with a recent gonorrhcea. Her habits 
were extremely irregular, and her intercourse had been for the last eighteen months 
promiscuous. The menses had during this period been much ir>terrupted, and for 
the last twelve months were entirely suspended. 

Her abdomen attracting attention from its increased size, the urine was submit- 
ted to examination, and presented a well-marked pellicle; a second trial gave the 
same result; some time after, she was removed to the obstetrical ward, and here 
delivered of a premature infant. 

2. Mrs. Mary Welsh, aetat. 37, May 25th, 1841, white obstetrical wards, had 
been for tv^'o years an inmate of the women's out-wards. On the 23d of July she 
married for the second time, having had by her former husband five healthy chil- 
dren. Some months after her marriage, her menstrual function was somewhat 
deranged; but for two months immediately preceding, and for three after, its regu- 
larity was uninterrupted. Since the 27th of October her catamenia have entirely 



1842.] Kane on Kiesteine. 85 

ceased, the cessation being- unaccompanied by the ordinary indications of a 
"change of life." Her sensations resembled those of previous pregnancies; and 
on the following March, five months after, she distinctly felt the motion of the 
child. 

Wishing, in the course of my observations, to procure some urine from preg- 
nant females well advanced, I sent for ten specimens of which there could be no 
doubt, and included this woman on my list. I was surprised to find that her urine 
presented no kiesteine^ and submitted it in consequence to another trial; and this 
giving the same result, I noted the case as an exception, and so mentioned it to 
Dr. Dunglison and to others. 

While in her eighth month, however, I made a third examination, which pre- 
senting also no pellicle, led to a close investigation of her case, and finally to her 
dismissal from the ward on my own responsibility. 

That there were many evidences of pregnancy, and that the absence of the 
peculiar pellicle had much influence on her discharge, will be seen from the sub- 
joined examination made in the eighth month. 

Mammse. — Large and protruding; much developed; nipple prominent; the disc 
somewhat tumefied, and the general condition rather firm than flaccid. By pres- 
sure, a yellowish, milky fluid exuded from the breast, and the papillae were quite 
mammelated from the enlargement of the follicles. Mdomen.— Tumid, and much 
protruding, the rugae of previous pregnancies having disappeared by the tension; 
the navel, although not prominent, was not depressed. On percussion, generally 
flat, but tympanitic around the umbilical region. Uterus examined per vaginam, 
rigid, rather patulous about the mouth; vagina very rugose and contracted, dry and 
badly lubricated. By auscultation and the stethoscope, I made out no foetal pulsa- 
tion, although opinions were divided as to its existence; a souffle was distinctly 
heard, but I did not feel myself competent to decide as to its character. By bal- 
lottement, no result. 

After carefully considering the above case, I discharged her, much against her 
own wishes and those of her fellow patients, to the female working wards, where 
she remains at the date of this paper without a change of symptoms. 

3. Isabella Smith, aetat. 25, entered the white obstetrical wards on the 20th of 
April, 1841, professing to be in the eighth month, and presenting so many indica- 
tions of well advanced pregnancy that no deception was suspected. A series of 
epileptic paroxysms, which prevented the usual more rigid examination, caused 
her temporary removal to the women's lunatic asylum, where, on the morning 
after her admission, I procured a specimen of her urine. The absence of a pelli- 
cle on two trials, made at the instance of Dr. Dunglison, satisfied me that she was 
an impostor; and on the 28th, during a well simulated paroxysm of epilepsy, her 
dress gave way, and disclosed an abundant mass of hair padding ingeniously 
arranged over the abdomen. 

4. Black obstetrical wards. This woman came into 

the ward in the sixth month, as she supposed, with arrestation of the menses, 
tumid abdomen, enlarged mammae, &c. 

At the time of procuring the first specimen of her urine, I was assured by the 
nurse and herself that they felt the motion of the child. No indications of the 
kiesteine were present, however, and a second trial giving the same result, she 
was dismissed from the ward. 



36 Kane on Kiesteine. [Ju^y 

5. Mary Patterson, setat. 30, in the women's venereal ward, supposed herself 
pregnant, and had so many of the signs as to render her case an undecided one. 
Her urine gave no pellicle, and in the result this test was found correct. 

6. I have at this moment before me a letter from Dr. T. Lindsey Walker, of 
Va., one of my colleagues at the Philadelphia Hospital, to whose intelligent inte- 
rest I am much indebted, in which he states, that of seven specimens of urine, 
presented under fictitious names, and at a distance of two miles from the place 
where they were voided, 1 successfully indicated the only four, which were those 
of pregnant females. 

7. >S'. C , aetat. 22. Her urine was presented to me by a medical friend, re- 
questing an opinion. The evidences of pregnancy were well marked, and to many 
conclusive. Repeated trials of her urine in no instance gave the kiesteine, and sub- 
sequent examination confirmed the accuracy of its evidence: she was not pregnant. 

8. Maria Hero, aetat. 15. This young woman, at the very commencement of 
my experiments, refused to give me her urine; and when at last I succeeded in pro- 
curing a specimen, it yielded no pellicle. I made a second trial, and this gave the 
same result. Embarrassed by this apparent contradiction of the other indications 
in her case, I determined to make a third trial, and obtained a perfectly marked 
kiesteinic pellicle. I learned on subsequent inquiry, that she had, on the two first 
occasions, borrowed urine from her neighbour. 

This was only one of very many cases of attempted imposture detected in the 
course of my examinations. 

9. Miss , setat. 23. Applied to Dr. N. Benedict, of this city, for a 

course of treatment for suppressed menstruation. Her previous character had been 
undoubted. He had felt an interest in the inquiries which I was conducting, and 
sent me a specimen of her urine for examination. 

It presented on the third day the kiesteinic pellicle so well marked as to leave 
no doubt in my mind as to the proper diagnosis of her case. Having reported to 
him accordingly, he declined administering emmenagogues, and in the result she 
reluctantly confessed herself in the second month of pregnancy. She is now 
awaiting delivery. 

With another case, of the many which I have had the pleasure of determining 
for the same gentleman, I will now conclude. 

10. Mrs. M M , aetat. 32. Since her marriage, which occurred five 

years ago, has been the mother of three children, the interval between them being 
of nearly uniform duration. At the expected period, experiencing well understood 
symptoms, she supposed herself again pregnant. Her urine, tested in the third, 
fifth, and seventh weeks, presented no pellicle. Her symptoms were now aug- 
mented by a host of sensible signs; and finally a fourth trial, made after averred 
quickening, giving no kiesteine, led me to consider her case as an exception, and to 
note it as such in my tables. 

Since that date, however, I am enabled to add her name to my confirmatory list; 
a subsequent examination making it perfectly evident that her condition is owing 
to other causes. 

P. S. — April 20, 1842. Since this dissertation was submitted to the 
Medical Faculty of the University of Pennsylvania, two papers on this sub- 



1842.] Kane on Kiesteine. 37 

ject have appeared; one by Mr. Letheby, in the London Medical Gazette of 
Dec. 24, 1841, and an elaborate paper by Dr. Stark, in the Edinburgh 
Medical and Surgical Journal, for January of the present year. 

The facts observed by Mr. Letheby accord generally with my own. He 
found "unquestionable evidence of kiesteine in forty-eight out of fifty cases 
between the second and ninth month of utero-gestation," and was unable, 
like myself, to " account for its absence in the two exceptions." In seven- 
teen non-pregnant women he found no indication of its presence; but detected 
it in, the urine of ten suckling women, immediately after delivery, and onwards 
to periods between the second and sixth months, when it disappeared. The 
few microscopic results which he gives coincide also with my own. 

Dr. Stark's paper is devoted to the signs of pregnancy, and among the 
rest to the state of the urine. He refers succinctly to his own observations 
relative to the kiesteinic pellicle, which he supposes to be derived from the 
suspended sediment; and he asserts that there exists a relative proportion be- 
tween these and the earthy salts which enter into the composition of the 
urine. His paper derives its principal interest from his researches into the 
character of the sediment. 

In the natural sediment of the urine of pregnancy, he was unable to 
detect the presence either of albumen or caseum by acids, alkalis, or al- 
cohol, with the aid of heat; but when he added a certain quantity of milk to 
the urine, both these principles were discovered readily by the aid of acids, 
the other tests producing no effect: when milk was added in smaller quan- 
tities, however, it was undis cover able by any reagent. Being unable to 
refer the sediment to any of the known deposites of the urine, though his 
investigations had immediate reference to its distinctive characters, he em- 
ployed ether to effect a separation of the animalized matter which he 
thought it might contain, and he supposes that he succeeded by this means 
in detecting a substance entirely different from any heretofore known. 

Failing to determine its constitution by chemical agents, he resorted to the 
microscope. He here found that this sedimentitious matter, whether ex- 
amined while yet held in solution by the recent urine, or when it had assumed 
the form of a deposit, or when it had been disengaged by ether, was com- 
posed of distinct transparent or " pellucid" globules, which when in their 
sedimentary condition bore a striking resemblance to the caseum globule of 
recent milk, but which when pellucid bore an equally strong resemblance to 
the serous or albuminous globule. 

Dr. Stark now reduced the question to very narrow bounds, by inquiring 
as to the identity of this sedimentary matter with albumen, caseum, fibrine, 
and gelatine. He thinks that its minute structure and chemical properties 
sufficiently distinguish it from the two first; — from albumen, because it dis- 
solves instead of coagulating upon the application of heat; from caseum, be- 
cause it is soluble in nitric and sulphuric acids, which exert on this principle 
a very contrary action. From fibrine, it has necessarily a still greater dif- 
No. VII.— July, 1842. 4 



38 Kane on Kiesteine. [July 

ference. There remains gelatine; and compared with this, the distinction 
was less striking. The globules of both under the microscope, were simi- 
larly formed: both were soluble in the acids and alkalies, arid by the aid of 
heat. The only distinctive particular seems to have been the action of tannin, 
which as is well known precipitates gelatine from its solution in water. 
Some of the natural sediments, dissolved in boiling water, and cooled to a 
blood heat, were treated with a decoction of galls: a flocculent precipitate was 
at once produced; but instead of gelatinizing upon cooling — it ivas deposited; 
and instead of becoming more solid and more easily separable, upon reboil- 
ing, it again underwent solution. 

Upon these grounds he attains the conclusion, which I give without com- 
ment, " that tbis substance is a matter sui generis <, an elementary substance 
or principle, forming in some measure a connecting link between the albu- 
minous and gelatinous elementary principles." This substance he proposes 
to designate by the name of *' Gravidine,^^ 

It is unnecessary to say, that this discovery of a new organic principle, if 
confirmed by future investigation, will be a matter of great interest. I must 
confess, however, that the distinctive characteristics of the new substance do 
not seem to me very decidedly marked in the results announced by Dr. Stark; 
and such is the complex, and often deceptive nature of the investigations of 
physiological chemistry, that we have a right to wait for renewed experi- 
ments before admitting too implicitly the certainty of those he has described. 

Dr. Stark considers that his experiments entirely subvert an opinion 
which has met with some favour regarding the theory of these appearances. 
Ever since the publication of Nauche's paper, the supposed presence of ca- 
seum in the urine of pregnancy has countenanced the idea entertained by 
Bird and others, already referred to, that the elements of the milk (not as 
Dr. Stark infers, the milk itself,) might probably exist in the urine: — as, 
however, the matter is neither milk nor caseum, a theory based upon their 
presence must necessarily fall. The conclusion may be a correct one so far 
as the chemical analysis is concerned; and yet the connection between the 
kiesteine pellicle and the mammary secretion may be adequately proved by 
other evidence. If even the Gravidine be regarded as a new organic prin- 
ciple, its properties are not so peculiar, nor its analogies with caseum so 
remote, as necessarily to imply the operation of different causes in the form- 
ation of the two. 

I have already mentioned my conviction, founded on personal observations, 
that the unmodified caseum is not found in the urine; but the presence of 
the colostral appearances under the microscope, and the numerous pheno- 
mena which I have described as attending the presence of the Kiesteine 
leave me no room to doubt its intimate connection with the condition of 
lactation. 



1842.] G\hson^s Case of Anchylosis of the Knee-joint, 39 



Art. II. — Case of complete Anchylosis — in lohich the Knee-joint iv as per- 
manently flexed — cured by an operation. By Wm. Gibson, M. D., 
Professor of Surgery in the University of Pennsylvania. Reported by 
Thomas L. Walker, M. D., of Albemarle, Virginia, one of the resident 
Physicians of the Philadelphia Hospital. [With two wood cuts!] 

The frequency with which Anchylosis succeeds to wounds, and inflam- 
mation otherwise established in articulations, will, it is hoped, render a 
report of the continued success of an operation, devised and first executed 
by Dr. J. Rhea Barton, for the relief of this misfortune, interesting to the 
public. I would not be understood as having reference to the less serious 
variety — that in which the rigidity is confined to the soft parts, in which 
partial mobility of the joint is still maintained, and to accomplish the cure of 
which, such simple treatment as the gentle use of the limb, combined with 
the application of suitable embrocations, is in most cases alone indicated. I 
allude exclusively to that condition, in which the parts, particularly apper- 
taining to the structure of joints, are disorganized, — in which there is a firm 
osseous adhesion between the ends of the bones, and in which, since the 
bones are so consolidated as to form one continuous shaft, there is perfect 
immobility of the joint, with a loss of all of its functions as such. 

It remained for the inventive genius of Dr. Barton, to prove to the pro- 
fession, the fallacy of the opinion, that this was an irreparable termination, 
and that it should be regarded rather as a fortunate result, than an evil 
amenable to surgical skill. In the number of the North American Medi- 
cal and Surgical Journal, for April, 1827,* he reported his first operation, 
and the circumstances suggesting the experiment. It was performed on the 
person of a sailor, whose hip-joint was perfectly anchylosed, and the limb 
so situated, as to overlap the unaffected one. In this case, there was the 
twofold indication of correcting the malposition of the limb, and of forming 
a new joint. Accordingly, the thigh-bone was divided (with a saw) through 
the great trochanter, and a part of its neck. This being done, the limb was 
readily straightened, and bony union having been prevented by daily move- 
ment of the limb, ligamentous attachments were formed, and an artificial joint 
resulted. After the lapse of sixty days, the patient stood erect upon his feet, 
with both heels alike touching the floor, and in a short time, possessed per- 
fect use of the new joint. 

The complete success of this operation, encouraged its originator to ex- 
tend its application; believing it equally adapted to the relief of anchylosis 
of other joints, as that of the knee, shoulder, elbow, great toe, and fingers. 
It was not till ten years had passed, however, that an opportunity presented 

* See also Philad, Journ. of Med. and Phys. Sci., Vol. XIV, p. 177 and 416. 



40 



Gibson's Case of Anchylosis of the Knee-joint, 



[July 



itself for the experiment. An intelligent physician, — who had for many 
years, from injury upon the knee, endured the inconvenience of anchylosis 
of that joint, and great deviation of the limb from its proper direction, — ap- 
plied to Dr. Barton for relief. In this case, an operation was performed for 
the purpose of straightening the limb. The case was reported in detail in 
the No. of the American Journal of the Medical Sciences for Feb. 1838, p. 
332. It will now only be alluded to, so far as it may be explained, by the 
details of a recent operation, successfully performed by Professor Gibson. 
The cases are almost identical, and a description applicable to the one, is 
equally true of the other. 

Last fall, during the attendance of Dr. Gibson as surgeon to the Philadel- 
phia Hospital, James Johnson, coloured, setat 17, was admitted. He, two 
years previously, whilst cutting with an axe, inflicted upon his right knee 
a wound, of which nothing more is known than that he recovered with a 
loss of the joint, and with the leg flexed backwards toward the thigh. In 

this situation he entered the Hos- 
pital, the leg being so flexed 
as to form an angle much less 
than a right angle with the thigh. 
(See accompanying figure.) He 
came in determined to submit to 
an operation, and expressed great 
anxiety that it should be per- 
formed. A careful examination 
satisfied Dr. Gibson, that the 
parts belonging to the joint were 
all destroyed: — ligaments, carti- 
lages, and the synovial mem- 
branes; and that it was a case 
of complete anchylosis. As in 
the patient last operated upon by Dr. Barton, he (Dr. G.) did not think that 
circumstances justified his attempting the double indication of forming a 
false joint and extending the limb too. His only aim, therefore, was to 
correct its malposition. Accordingly, everything seeming to favour the 
operation, both as to the will and robust health of the patient, and the 
entire concurrence of other surgeons consulted by Dr. Gibson, it was deter- 
mined on. 

Nov. 17th, 1841.— The patient having been for several days restricted in 
his diet, was brought forward, prepared for the operation. Before a full 
attendance of medical students, and many eminent physicians, the proposed 
operation was explained by Dr. Gibson; after which, he proceeded as fol- 
lows: — Two incisions were made, as in the operation of Dr. Barton; the 
first extending from the outer to the inner side of the limb, and passing im- 




1842.] Gih&ou^s Case of Anchylosis of the Knee-joint, 41 

mediately above the patella; the second commencing on the outer side, two 
and a half inches above the first, and meeting it at an acute angle on the 
inner side. These incisions penetrated to the bone, engaging the integu- 
ments, the tendon of the extensor muscles, and some of their fibres. The 
soft parts included between the incisions being dissected off and turned back, 
the bone was exposed to view. A portion of the femur, of a wedge shape, 
was then removed with the saw, having a base upwards of two inches and a 
half anteriorly, and reaching to within a few lines of the posterior surface of 
the bone. The operation was then concluded by inclining the leg back- 
wards, which caused that portion of the bone's diameter, undivided by the 
saw, readily to yield, and the solution of continuity to be made complete. 
This method of accomplishing the separation of the bone, was regarded as 
an important step in the operation, inasmuch as it guarded the popliteal artery 
against wounds from the saw; and the dovetailed edges of the opposed sur- 
faces were influential in fixing the extremities of the bones, until the 
asperities of these surfaces were removed by absorption, or by the formation 
of new matter. No blood-vessels were divided requiring the ligature or com- 
pression. The operation was completed in a few minutes, and the flap 
being returned to its place, and secured by the interrupted suture, light 
dressings were applied. The patient, lying upon his back, was put to bed, 
with the limb supported upon a double inclined plane, having an angle cor- 
respondent to that of the knee, before the operation. As great care was 
necessary to provide against pressure upon the popliteal vessels, the limb 
reposed on two bran bags, which were fastened to the edges of the plane, so 
fashioned, that its angularity could be varied, without being removed from 
beneath the leg, as its extension might require. The vacancy between the 
bags was carefully supplied with cotton. Very slight hemorrhage followed, 
which, proceeding from the division of one of the articular arteries, stopped 
spontaneously in a short time; and except for a slight oozing, which con- 
tinued for two days, there was no sign of hemorrhage afterwards. 

In the evening, the patient suflTered very little pain; complaining only of a 
slight uneasiness in the inguinal region, which was attributed to the position 
of the limb; was indisposed to sleep, consequently took fifty drops of 
laudanum. 

I8//1. — Passed a comfortable night; was without pain, and felt perfectly 
easy; oozing from knee very inconsiderable; rigidity of muscles diminished, 
and leg less contracted. 

19^^. — Slept all night without pain. Pulse full, strong, and regular (about 
72 in the minute). Leg had, by force of gravitation, extended itself a good 
deal. 

20/^. — Enjoyed undisturbed sleep throughout the night without any 
laudanum; complains of slight pain opposite the lesion of the bone; no fever; 
appetite good; bowels opened naturally. The dressings removed for the 



42 Gibson's Case of Anchylosis of the Knee-joint, [July 

first time, and the leg allowed to extend itself. Measurement proved the 
height of the angle to be diminished by three-quarters of an inch. Simple 
dressings applied again. 

21 5/. — Continued to do well. No fever or pain; towards evening, slight 
uneasiness endured, from the stretching of the tendons. Extension of leg 
increased by full another inch. 

23(/. — Limb was approaching the extended condition fast. No fever. In 
consequence of slight pain experienced, patient was allowed forty drops of 
laudanum. 

24^A. — Bowels were again opened. Passed a restless night, from pain in 
the foot, caused by the heel's accidentally coming in contact with the splint. 
Suppuration commenced. Laudanum repeated. 

25/A. — Entirely free from pain. Bowels again opened. No fever. The 
extension of the leg required the splint to be let out. The extension pro- 
gressed so rapidly, that a pad was applied to the sole of the foot, by which 
resistance was opposed to the direction of the elongation of the leg. 

26/^. — Wound discharged freely. Pulse a little accelerated. Towards 
evening the knee stripped, and newly dressed. Sutures all free. 

Dec. 5th. — Between the 26th of Nov. and the 5th of Dec, nothing 
transpired worthy of being mentioned. The patient continued uniformly to 
improve, the limb to extend itself, and his general health such as to require 
no interference on the part of the surgeon. On the 5th, the straightening of 
the limb was sufficient to justify the removal of the splint, for which a simple 
box was substituted. This was carefully lined with carded cotton, no part 
of the leg or foot being suffered to rest upon the wood. The comparative 
length of the two limbs was taken, measuring from anterior superior process 
of the ilium downwards. As far as an accurate measurement was obtained 
we were induced to give the sound limb an excess of an inch and a half. 

lith. — Since the date of the preceding note, the patient's condition was 
very favourable. No unpleasant symptom appeared. The wound continued 
to heal. Suppuration was so abundant as to require two dressings daily. 
Had no pain. Slept naturally. Appetite was good, and digestive functions 
perfect. In consequence of the too rapid growth of granulations, red pre- 
cipitate ointment was applied to the wound of integuments, and sponge tent 
introduced into the upper incision, to favour the escape of pus. Tumefac- 
tion of the knee commenced. Pulse somewhat excited. 

IQth. — Wound improved regularly after the application of the ointment. 
Tumefaction of knee increased. No pain endured. The secretion of pus 
was so copious, that an opening was made near the head of the fibula, — 
which situation being more depending, matter to the amount of eight 
ounces flowed out. Symptoms of debility now began to manifest themselves. 
Pulse was quickened, 112. Appetite continued good, and bowels naturally 
soluble. 



1842.] 



Mettauer on Hypospadias and Epispadias. 



43 



23c?. — Progressive improvement. Except the irritation symptomatic of 
the free suppuration, nothing was observed. The pulse was regularly 
excited, though the patient always expressed himself, as being perfectly 
comfortable. Tumefaction of knee diminished. 

Jan, 5th, 1842. — From the 23d of Dec. to this time, suppuration con- 
tinued free. The orifice made with the lancet, enlarged itself by ulceration. 
Pulse remained quick, but general appearance improved. In consequence 
of a sinus seeming to run up the thigh, a seton was introduced through the 
opening opposite the lesion of the bone, and brought out two inches above. 

I2th.' — The tape withdrawn. The discharge diminished. The bones 
were found to be firmly united. Patient was allowed to sit up with the 
leg supported at a right angle with his body. 

26th. — Patient was able to walk with 
the assistance of crutches. Wound not 
entirely healed. 

Feb. Ibth. — Wound every where 
closed. Could bear the weight of his 
body with difficulty. The leg shortened 
nearly an inch. Walked without the 
enclosure, assisted by crutches. General 
health perfect. 

May 1st. — For the last two months the 
patient has walked about continually with- 
out the use of a crutch or a stick; and lat- 
terly has been twice to town and back on 
foot, — having walked three or four miles 
without the slightest inconvenience. The 
accompanying figure shows the present 
appearance of the knee. The knee at this 
time is only half an inch shorter than the other. 




Art. IIL — Practical observations on those Malformations of the Male 
Urethra and Penis, termed Hypospadias and Epispadias, with an Jino- 
malous Case. By John P. Mettauer, M. D,, of Prince Edward 
County, Virginia. 



The great importance of malformations of the male genital organs, and 
the impression that a void exists to some extent relative to their surgical 
treatment, have induced us to draw up an abstract of our experience in the 
treatment of these mortifying and disgusting imperfections. 



44 Mettauer on Hypospadias and Epispadias. [July 

The malformations to which we shall direct attention are those preter- 
natural openings, or fissures, on the under and upper surfaces of the penis, 
termed Hypospadias and Epispadias; the former epithet being given when 
the openings are on the under surface of the penis, and the latter when they 
are on the superior surface of that organ. 

The former is much the more frequent form of these imperfections. 
These openings occur in the median line, and in almost every point between 
the meatus and neck of the bladder, though they most frequently occur 
near the anterior extremity of the penis; and they are liable to every possible 
variety of form and shape. They are sometimes round and exceedingly 
small, and transmit the urine with great difficulty. Occasionally they close 
up and prevent the escape of urine altogether. More frequently, however, 
they are large and vary in form from an oval to a fissure, or slit. When 
of an oval form, their margins are generally labiated and more or less thin. 
When they appear under the form of a fissure, they may extend nearly or 
quite the whole length of the penis, presenting the opening very much as if 
the urethra had been artificially slit open. If confined to the glans only, 
these fissures impart a most singular appearance to the organ, resembling in 
some degree the head of a fish laid open on its under side. Occasionally, 
the last named malformation is complicated with a permanent flexure of 
the penis at its cervix. 

In many cases, the urethra is entirely deficient from the preternatural 
orifice quite to the extremity of the penis. Now and then the organ is 
greatly shortened, or preternaturally lengthened and thickened, with a cor- 
responding dilatation of the urethra into a pouch, as complications of the 
infirmity. And, finally, epispadias occasionally is to be met with as a 
complication of hypospadias, and then the urine as it passes from the blad- 
der, flows from both surfaces of the organ at the same time forming two 
distinct streams. When this complication displays the glans open its 
whole length, an appearance not very unlike a turtle's head is presented. Oc- 
casionally, though rarely, the cleft in this complication occupies the whole of 
the penis, from the extremity of the glans to the arch of the pubes. 

Epispadias is of rare occurrence, but when met with presents appearances 
of the openings very similar to those already described under the head of 
hypospadias. 

In both forms of the malformation, the urethra may terminate without 
an external opening for the escape of urine; and in early infancy, such a 
modification of it occasionally occurs, as the cause of those distressing ex- 
amples of infantile retention of urine, from which such terrible consequences 
have been known to follow at that tender period of life. Every form and 
variety of these imperfections, is distinguished by a greater or less deficiency 
of the prepuce; and sometimes, too, it is either entirely absent, or preter- 
naturally superabundant. 



1 842.] Mettauer on Hypospadias and Epispadias, 45 

These malformations are almost always congenital, and must, when this is 
the case, be referred to arrest of development. Occasionally they have been 
produced by accidents, and by artificial means. Abscesses along the rapheal 
line, have resulted in a species of hypospadias, when the openings formed by 
art, or spontaneously for the evacuation of matter, have remained unhealed. 
Laceration of the urethra has, likewise, produced something of the same 
kind, when it has occurred along the rapheal line, and has been followed by 
sloughing of the parts. 

The operation of puncturing the bladder in retention of urine, has also 
produced a form of this malformation, especially when the urethra instead 
of the bladder has been penetrated. These examples, however, should be 
regarded rather as fistulous openings from accidental causes, than instances 
of hypospadias. The case of the unfortunate shepherd cited by M. Riche- 
rand in his physiology, is the only one known to us produced by design; 
and is remarkable for the great extent of the fissure, — which it is stated ex- 
tended from the extremity of the glans nearly or quite to the arch of the 
pubes; and, for the complete separation of the corpora cavernosa on both 
surfaces of the penis, so as to impart to it the appearance of two distinct 
organs. In this case the corpora cavernosas were gradually separated by the 
shepherd's own hand, aided at different times by the use of certain instru- 
ments, to increase the irritation which became necessary to elicit emission; 
and each corpus cavernosum possessed the erectile power. 

Every variety of these malformations exposes their subjects to more or 
less inconvenience in urinating; and sometimes individuals suffer great pain 
and anxiety, especially when the orifices are small, or when they become 
obstructed, or close up, as will occasionally be the case. The parts conti- 
guous to such openings are liable to excoriate, and to become exceedingly 
tender and irritable, so as to occasion much distress during urination. But, 
generally, they become most annoying on account of the mortifying defor- 
mity they produce, and from the impediments they too frequently oppose to 
sexual intercourse, and more especially to matrimony. Occasionally, too, 
the mental depression which always accompanies these imperfections, se- 
riously impairs the corporeal health; and in some instances it has resulted 
in epilepsy;* and a wasting melancholy, and even in confirmed mental de- 
rangement. Sometimes the local irritation connected with these malforma- 
tions, seriously impairs the constitutional health, by first inducing seminal 
weakness, or losses; and thereby producing indigestion; irregular bowels; 
loss of appetite; fever; debility; emaciation; disturbed rest; an endless 
variety of nervous symptoms; and, extreme susceptibility to colds, or to be 
morbidly impressed by vicissitudes of atmospheric temperature. 

* A case of the kind passed under our care, was of many years standing, and yielded, 
finally, after the employment of a great variety of remedies, to the crusta genu equina, a 
most valuable therapeutic agent in such affections. 



46 Mettauer on Hypospadias and Epispadias, U^^V 

Treatment. — Many, nay we believe all, of these malformations may be 
corrected, or greatly relieved by proper treatment, although they have in nu- 
merous instances been regarded as irremediable. Hypospadias of the more 
simple form, or when the opening is situated only a short distance from the 
extremity of the glans, and the urethra between those points is either defi- 
cient, or if present too contracted to allow urine to pass, requires an exceed- 
ingly simple and easy treatment. Introducing a small trocar about the size 
of the natural passage from the opening, along the tract usually pursued by 
the urethra, quite through the extremity of the glans, will eflectually open 
the passage. Care should be taken, however, during the operation, that the 
instrument shall not cut through the thin rapheal wall, especially in the 
glans; and to prevent such an accident, the cutting edges of the trocar should 
be directed to the sides of the penis, and along the angle between the cor- 
pora cavernosa. Firmly supporting the penis by grasping it with the left 
hand, and flexing it at the same time at the 'opening, so as to enable the 
operator to enter the trocar accurately from the termination of the urethra, 
little difficulty will be experienced in giving a proper direction to, and in 
passing the instrument out through the extremity of the glans. As soon as 
the passage is opened, a gum elastic tube of proper size and length should be 
introduced quite through it, and at least eight or ten lines beyond it into the 
urethra. The tube should fill the newly formed passage completely, and 
must be cut off at its entering extremity, and rounded off so as to enter 
"without wounding the parts: it must also be headed at its outward extremity 
with sealing wax. By filling the passage completely its introduction will 
arrest the hemorrhage at once; and there will be less danger of the displace- 
ment of a tube fitting the passage tighUy. Where fairly introduced, the tube 
may be securely confined, by connecting its head to a kind of hood which 
firmly embraces the penis, with threads, or very narrow tapes. Thus ad- 
justed it serves to give passage to the urine during urination, and to maintain 
the newly formed urethra well dilated, and of proper size, until it inflames and 
suppurates sufficiently to prevent urinal infiltration into the surrounding tex- 
tures. Generally the tube should remain in the passage two or three days, 
or until free suppuration is established. After this it may be dispensed with, 
and a short bougie of proper size introduced in its stead, for half an hour at 
a time, three or four times daily, until the passage ceases to matter; it should 
then be introduced once or twice daily for several months, or, until the pas- 
sage is firmly established. Occasionally, a catheter carried freely into the 
bladder may be employed instead of the short tube, for the purpose of dilat- 
ing the newly formed passage; and when there is reason to believe that the 
corpora cavernosa, or the corpus spongiosum are wounded, it should inva- 
riably be preferred; it answers admirably for restraining hemorrhage, and 
preventing accidental infiltrations of urine into the surrounding textures. 
When the catheter is employed, it should be secured in the passage as 



1842.] Mettauer on Hypospadias and Epispadias. 47 

already advised with respect to the short tube; and must be guarded with a 
stopper, to prevent involuntary discharges of urine from the bladder. 

If the parts inflame much, as will sometimes be the case, they should be 
freely bathed with cold water; cold elm-tea; cool saturnine lotions; or, warm 
fomentations may be used, if found more agreeable. Occasionally, cataplasms 
will be required to allay the irritation; and they should invariably consist of 
bland mucilaginous or farinaceous substances. The bowels should be opened 
freely from time to time. Rest will be highly beneficial, not only in ena- 
bling the surgeon to maintain the proper adjustment of the dilating means, 
but, also, in guarding against, and in correcting the traumatic inflammation. 
Patients, generally, should be confined in bed, and undressed, for at least 
five or six days after the operation, and even longer, if there is much in- 
flammation and an antiphlogistic diet directed. 

The fistulous openings may be touched with nitras argenti and the slough 
scraped off" with a knife, before the passage is restored, or afterwards.* We 
have adopted both methods, but think it best to employ the former, as the 
surgeon is then enabled to accomplish an immediate cure. The denudation 
must be efl;*ectually performed, and may be done by scraping ofl" the dark 
eschar with a small scalpel. The surfaces thus denuded readily unite as a 
fresh cut; or by granulations which amalgamating efl'ectually close the ori- 
fice. Sometimes it will be necessary to apply the caustic repeatedly before 
the cure is effected. And occasionally it will be required to approximate the 
margins of the opening, either with adhesive plasters, or a bandage, to ena- 
ble us to effect its obliteration. These openings should never be denuded by 
excising their margins, as too great a loss of substance would then be the 
consequence. In all the examples of this form of hypospadias, the plan of 
treatment which we have briefly described, will be found to answer per- 
fectly. The same principles of treatment should guide us in cases in which 
the opening is low down on the penis, or in the perineum; in these last how- 
ever a longer trocar will be required to form the passage, as well as longer 
tubes or bougies to maintain it dilated. The catheters for this purpose 
should be long enough to enter the bladder; and they must fill the passage 
tightly for the double purpose of rendering it free, and to put an immediate 
stop to the traumatic bleeding which is sometimes very profuse. After free 
suppuration is established — which will be the case in three or four days, 
and sometimes earlier — the tube may be removed. It should never be left 
out oi the passage, however, long at a time for several days; and must inva- 



* This mode of denudation is peculiar to us, and has been almost daily in use in our 
practice for twelve years. It will be found very convenient in deep and inaccessible 
locations where cutting^ instruments cannot be effectually employed: and is as effectual 
as the mode by excision, if not more so. Union may be effected through it either by the 
first or second intention. 



48 Mettauer on Hypospadias and Epispadias. [J"ly 

riably be replaced before urination, to prevent the painful scalding which 
would certainly follow, as well as to guard against the possibihty of infil- 
tration of urine. 

The directions already given in relation to the mode of retaining the tube 
securely in the bladder and passage, and for guarding against involuntary 
discharges of urine with a stopper, must govern in the cases now under ex- 
amination. After a week from the operation, patients may be allowed to 
urinate without the use of the tube; and for the purposes of dilating the pas- 
sage after this period, either tubes or bougies may be employed: these in- 
struments must be used once or twice daily, for months after the operation. 

The closure of the orifices in these examples of hypospadias will require 
a plan somewhat different from that already considered. Being generally 
of large size, and situated in a part of the organ abounding in loose textures, 
their margins may be readily and rapidly denuded by excision; and this 
mode we have uniformly adopted, unless there should be a deficiency of 
substance. The margins may be pared off with a keen delicate knife; and 
this operation should be effectually done. As soon as accomplished, the 
denuded surfaces must be accurately brought together and confined in close 
contact, either with adhesive plasters or the uniting bandage; or, by the 
introduction of one or more points of the interrupted suture; and these steps 
should always immediately succeed the introduction of the tube after the 
formation of the new passage, for the reasons already urged. In some 
cases, however, the nitras argenti may be depended on exclusively, or be 
employed as an auxiliary where the surfaces denuded by incision fail to close 
up the openings completely. The actual cautery we have never used in 
these malformations, nor are we inclined to recommend so terrific a mea- 
sure, especially when children are the subjects to be treated. When the 
malformation is distinguished by an open cleft or fissure, from the termina- 
tion of the urethra, quite to the extremity of the glans, or nearly so, modi- 
fications by no means uncommon, the margins must be carefully denuded 
with a knife; or, by touching them with nitras argenti, and then carefully 
scraping off the eschars until they are perfectly denuded. The passage 
corresponding with the tract of the urethra must then be filled with a tube 
or catheter of proper size, and the denuded margins be brought together so 
as to embrace it, and at the same time to be in exact and close contact 
throughout their whole extent. In this condition they are to be retained, 
and securely fixed with court-plaster applied in successive narrow strips 
around the organ the whole extent of the fissure. Thus adjusted, the whole 
must be confined by a narrow soft bandage applied so as to act upon every 
part of the organ requiring support, and some distance below, the more 
effectually to prevent displacement. In the application of the bandage no 
more force should be employed than is sufficient to support the under dress- 
ing, and to maintain the apposition of the denuded margins perfect. If ap- 



!842.] Mettauer on Hypospadias and Epispadias. 49 

plied very tightly, great distress and excoriation, or even sloughing may 
follow. 

The tube must now be carefully connected with the bandage by threads 
or narrow tapes, and guarded with a stopper. In most of these cases, too, 
the tube should extend quite into the bladder; as by that arrangement it 
would be less liable to accidental displacement, and more effectually at the 
same time prevent the escape of urine along the urethra. It must be kept 
in until free suppuration is established, which will generally be in from three 
to four days. Generally, the tube should not be removed sooner than the 
fourth day; and if no inconvenience attend, it may be allowed to remain in 
until the fifth or even the seventh day after the operation. When removed 
the tube should be drawn out very gently and gradually, so as not to disturb 
the lips of the recently united parts. 

After the tube is withdrawn, the meatus may be gently washed with tepid 
or cold water, should the parts require it. The tube may be replaced after 
a few moments, and kept in for one day more. If union of the lips takes 
place early, the bandage may be removed for the first time on the third or 
fourth day; but generally it will be most safe to suffer it to continue on until 
after the removal of the tube the first time. The plasters, if they adhere, 
should not be disturbed during the whole treatment. If they loosen, new 
ones must be put on. The plasters and bandages must be continued until 
firm union takes place, and reapplied daily if necessary. As soon as there 
is good reason to believe that pretty firm union has taken place, the tube 
may be dispensed with in some measure; but it should be introduced once 
or twice daily, as long as matter escapes from the meatus, for a few mo- 
ments at a time, to prevent any narrowing of the passage. 

This form of hypospadias fortunately does not often present the fissure of 
very great extent; and being confined almost exclusively to the glans, cer- 
vix, and a small part of the penis beyond it, comparatively little diflficulty 
will be experienced in its treatment in a large majority of cases; and the plan 
which has been premised will generally be found to meet every indication. 
When it involves the penis behind the glans to any considerable extent, the 
interrupted suture should be employed to close the fissure after its margins 
have been well denuded by excision of their epithelium. The points of the 
suture must invariably be inserted fully three lines from the margins, if not 
more, and in sufficient number, and near enough together to approximate 
them, and to close the fissure perfecdy. Over the sutures narrow strips of 
court-plaster should be placed in succession, and nearly to encircle the penis; 
the whole to be supported by a narrow, soft bandage. In this form of the 
imperfection, a long tube or catheter should always be employed as the 
means of maintaining the passage; and should be introduced quite into the 
bladder before the sutures are applied; over which, as it is placed along the 
passage, the margins of the fissure can be readily brought in contact, and - 
coaptated. The after treatment must be governed by the directions already 
No. VII.— July, 1842. 5 



50 Mettauer on Hypospadias and Epispadias, [July 

given. It may be remarked, however, that the adhesive plasters should be 
allowed to remain on as long as they adhere; and when to be removed, they 
must be carefully moistened with a soft wet sponge saturated with warm 
water, applied to them for a few moments, and then taken off with delicate 
forceps, loosening the extremities first so as to peel them alternately from 
each extremity to the line of union. This material, it may be remarked 
here, is the very best for all delicate operations requiring adhesive plasters; 
and our commendation of it is based upon ample experience during the last 
twenty-five years in numerous and satisfactory trials. 

The treatment of epispadias should be directed by the preceptis which 
have been presented in regard to the several modifications of hypospadias. 
Generally, it will be much easier to manage the former than the latter mal- 
formations, even if they consist of a mere opening or fissure, by reason of 
the greater width of their margins, which afl?brds more surface for a ready 
and firm union of them. Complete cures can generally be effected in these 
malformations in two or three weeks. 

When the malformation is compounded of both hypospadias and epispa- 
dias, as in the case of the shepherd already referred to, and that adverted to by 
Mr. Liston, it will be necessary to denude the opposing surfaces their whole 
extent, either, by paring off" their epithelium with a scalpel; or, by first cau- 
terizing them with nitras argenti, and then scraping oft' the dark eschar. A 
tube of proper size may now be interposed between them extending fairly 
into the bladder, and placed along the fissure, so as to form a passage in the 
angle between the two corpora cavernosas on their under surfaces where they 
are approximated. The two columns are now to be placed in exact contact 
throughout their v^'hole extent. Thus arranged, they must be confined with 
a sufficient number of points of the interrupted suture introduced first, along 
the dorsal fissure, and then aloug the under surface of the organ, to maintain 
a perfect juxtaposition of the denuded surfaces: here the sutures should not 
include much, if any of the elastic ligament, but extend only a sufficient 
depth into the skin, to enable them to confine the parts firmly. Over the 
sutures narrow strips of court-plaster should be applied in succession, and 
long enough to encircle the organ completely; and the whole to be supported 
by a soft narrow bandage. Great care will be required in the coaptation of 
the parts, so as to enable them to unite perfectly, and to give to the penis a 
natural form, especially about the glans. It will also be necessary to be 
particular, in placing the tube properly along the tract in which the urethra 
is to be formed. Simply compressing the sides of the organ with the fingers 
until the tube presents fairly on the under surface of the penis, will enable 
the surgeon to give it the proper position; and this should be done after the 
bandage is applied. 

The tube employed in this operation must be headed with sealing wax, 
and should never project more than five or six lines beyond the extremity of 
the glans. It should also be guarded with a stopper, and securely fixed in 



1842.] Mettauer on Hypospadias and epispadias. 51 

the passage by making it perforate the cul de sac of a hood which firmly em- 
braces the anterior portion of the penis. Thus adjusted, the dressings must 
remain four or five entire days. If the traumatic inflammation becomes vio- 
lent, cold water should be freely applied, either by using compresses or 
soft sponges saturated with cold or iced water to the dressings. Generally, 
this expedient will not be required, as the inflammation is not disposed to 
become excessive. The urine should, during the whole treatment, be drawn 
off after short intervals, to prevent as far as possible the danger of violent 
expulsive efTorts of the bladder forcing any portion of that fluid around the 
tube, and into the line of expected union of the corpora cavernosa. In all 
other respects the after treatment is to be conducted pretty much as advised 
in the preceding modifications already described; and the cure will be ac- 
complished in two or three weeks. 

Should these malformations be complicated with an unsightly and incon- 
venierit curvature at the cervix, or any other portion of the penis, the con- 
tracted part must be divided by subcutaneous incisions in succession, until 
the organ is liberated. The contracted structures can be easily distinguished, 
and readily divided. They are generally situated in the subcutaneous cel- 
lular texture, which from some cause has lost its soft and yielding qualities, 
and, as in cases of burns, refuses to elongate with the development of the 
contiguous textures, and in that way may produce the curvatures in question. 
Occasionally, however, the deformity depends on a preternatural shortening 
of the elastic Ligament. In either case the deformity may be readily cor- 
rected by division of the contracted textures, taking care, however, to em- 
ploy an exceedingly delicate instrument in the operation. After the con- 
traction is removed the organ may be kept perfectly straight, either by using 
a short tube introduced, as already suggested, below the division, until the 
parts heal; or, by employing at the same time delicate splints on the four 
surfaces of the penis, confined by a bandage as already advised. When the 
eontraetion is slight the tube properly confined with a soft bandage will efl^ee- 
tually relieve the deformity. In bad cases, it will always be most advisable 
to employ the tube and splints conjointly. In a few days the parts heal 
|9€rfectly. 

Malformations, when complicated with extensive dilatations and elonga- 
tions of the urethra and penis, and the organ in those parts incapable of an 
-erectile movement, present most unsighdy as well as unfortunate deformi- 
ties. Such modifications, unless corrected, completely preclude all sexual 
^itercour^e, as the organ by reason of its permanent flaccidity and nonerectile 
condition must be utterly incapable of penetrating into the vagina, even 
should that passage be free from all obstruction at its orifice. An exceed- 
ingly interesting case of this kind having recently passed under our care and 
been managed successfully we shall give a detailed account of its history, 
and treatment, as likely to fyrnish the best commeijtary upon such forms of 
hypospadias. 




52 Mettauer on Hypospadias and Epispadias, U^^f 

Mr. , aetat about 19 years, of moderate statUre, good general health, 

though suffering much from depression of 
mind, and exceedingly gloomy from the pain- 
ful consciousness of his mortifying deformity^ 
was placed under our care early last autumn^ 
This penis (see fig. 1) was greatly elongated, 
measuring fully eight inches from the scrotum 
to the extremity of the glans in the nonerect- 
ed state. The anterior three-fifths (e, d, c) une- 
qually dilated in its lateral dimensions, with a 
^1 \^ remarkable expansion of the corresponding 
portion of the urethra, and perfectly flaccid, 
and nonerectile: the transverse diameter of this 
portion of the organ when largest was fifteen 
^^ iines^^, from which part it tapered to the 

glans, as well as to the pubic portion. The urethra of this part of the organ 
was capable of containing fully tv/o ounces of fluid; and the cavity was 
bounded anteriorly by the concave glans; posteriorly by the rough granular 
surface of the pubic two-fifths, or stump of the organ; and laterally by walls 
formed of the urethra greatly dilated, the elastic ligament and integuments* 
The pubic portion which we have denominated the stump {e,f, g) constituted 
about two-fifths of the penis, was well formed, capable of erectile move- 
ment, and terminated abruptly, so as to form the pubic extremity of the 
cavity already described, with the orifice of the urethra projecting from its 
surface so as to form a kind of os tincae looking into that cavity. Low down 
in the perinseum, about ten lines anterior to the verge of the anus, and in the 
rapheal line, there existed an extremely elliptical orifice about four Ihies in 
extent, and bounded on its margins by a kind of labiated reduplication of the 
integuments, resembling in some degree the labia pudendi of females, through 
which the greater part of the urine escaped. The urethra about eight lines 
in extent anterior to this orifice was nearly impervious, and transmitted only a 
few drops of urine during urination. On the central part of the expanded 
portion of the urethra, which we have termed the pouch, and in the rapheal 
line, an opening existed at the time we examined into the case, which had 
been formed artificially, but had become completely fistulous, of an oval 
form, and four lines in length, through which a few drops of uiine would 
occasionally appear. From the meatus, a mueo-purulent discharge frequently 
escaped, especially when the urine was forced to take that direction by par- 
tially closing the perinseal opening with the end of the finger. 

With the deformity Ave have attempted to describe, strong sexual desires 
were associated. The testes were perfectly formed and of large size. Our 
examination induced to an encouraging opinion as to the practicability of 
correcting the deformity; so far, at least, as to place the organ in a condition 
favourable for sexual intercourse; and such unexpected good tidings to the 




1842.] Mettauer on Hypospadias and Epispadias. 53 

young' man, borne down by melancholy and unhappy afflictions, caused a 
lively expression of joy and happiness; and he at once formed the philoso- 
phic determination to submit to any operation we might think proper to 
undertake for his relief. In a few days the following plan was adopted; 
and, as the sequel will show, it resulted in the perfect correction of the mal- 
formation. 

The patient being placed in a strong light resting upon a bed of conve- 
nient height, and on his back, our first aim was to transplant the glans upon 
the erectile stump. To accomplish this, we laid open the pouch its whole 
extent by making an incision along the rapheal pj„ 2. 

line. We next removed a bell from the interior of 
the cavity seven lines in width entirely around the 
base of the glans, and quite to that organ, so as to 
leave that part of the wall of the pouch to consist ^^^, 
only of common integuments and cellular mem- 
brane. A like belt was removed from the inferior 
portion of the pouch, quite down to the circum- 
ference of the face of the erectile stump. We 
then carefully denuded the face of the stump in 
every part of it. After the blood had been effectually spunged away from 
the new surfaces, the glans was placed with great care upon the face of the 
stump, taking care that the denuded margin at its base should correspond 
accurately with the circumference of the opposing denuded surface of the 
stump. A short bougie was then passed into the meatus, and carried along 
the urethra of the stump, nearly to the contracted portion of it, with the 
design of enabling us to retain the glans more easily and perfectly in its 
proper position. Thus arranged the glans was firmly connected to the erec- 
tile stump by eight points of the glover's suture, applied in succession 
through the glans and stump at the fraenum; then on the middle of the dor- 
sum and at the base of the glans through these portions of the integuments 
immediately contiguous to the glans and stump; next on each side through 
the opposing tegumentary duplications of those parts; and in succession 
until the whole series was completed. Care was taken, however, in the 
introduction of the sutures through the tegumentary laminae, that ample 
space between them was allowed for the free passage of blood to the glans. 
When the sutures were tightened tliey fixed the glans most perfectly and 
securely on the erectile stump, and imparted to the organ thus modified, an 
improved appearance highly gratifying. 

The glans thus transferred to and situated upon the erectile stump, neces- 
sarily shortened the penis, and required that the tegumentary intermedium 
which had been left, should be inflected upon itself so as to form a loop-like 
body on the dorsal and lateral portions of the organ immediately behind the 
base of the glans. (Fig. 2, b, a, c— /, d, e, the orifice opening into the cavity 
of the intermedium.) This loop-like body was unavoidable, inasmuch as the 

5* 



54 Mettauer on Bypospaclias and Epispadias. [July 

glans could not possibly have been supplied with a sufficiency of blood for 
its nutrition and support, had the intermedittm been cut away at once. It 
was large and exceedingly inconvenient as it now existed, and would have 
interfered with the dressing whieh we designed using at this stage of the 
operation. To remedy these inconveniences in son>e degree, we removed 
about one half of the band of which it was formed, talking care not to dis- 
turb the sutures during the operation; and as the section was effected with 
scissors little pain was produced by its excision. We found it necessary tO' 
take up several arteiies, and one of large size after this little operation, so 
profuse and annoying was the flow of blood from them. After carefully 
spunging away the blood we covered the margins of the loop-like body with 
dry lint, then put on a few very narrow strips of adhesive plaster, and over 
them a narrow, soft bandage, applied in such a manner by circular, oblique, 
and reverse turns, as to embrace and support the parts with tolerable firm- 
ness. We next fixed the bougie in the urethra by eonne"cting threads be- 
tween its extremity and the bandage. 

In this condition the parts were permitted to remain until the third day 
after the operation. To moderate the inflammation cokl water was applied 
freely after the parts began to swell, and continued until free suppuration 
was established in all the incisions. Little inflammation followed the ope- 
ration, and by the third day free suppuration was established throughout alt 
of the ununited cut and denuded parts. The constitutional fever, too, was 
very slight. 

On the third day the dressing was removed, and the parts about the con- 
nection of the glans and stump appeared to have united perfectly. After 
carefully washing the wounds they were redressed as in the first instance, 
only the bougie was omitted. In this manner the dressings were renewed 
daily until the eighth day, when three of the sutures were cut away from 
the under part of the penis. After this a very light dressing was employed;, 
and the remaining sutures wei-e removed daily until all were taken away. 
The union, as soon as it was deemed safe to examine the parts carefully,, 
which was on the twelfth day after the operation, was found perfect and 
firm. The margins of the intermedium did not heal over until the twentieth 
day; and fully three months ela{)sed from the date of this operation, before all 
inflammatory tenderness of the parts involved, subsided. 

During this long period, the unsightly fold of integuments left for the sup- 
port of the glans, occasioned not a little annoyance to the patient, as its 
bulk and peculiar form continually admonished him that the organ was yet 
imperfect, and reminded him, too, that another operation yet awaited him 
before the cure could be effected, which he now greatly dreaded. Three 
months from the date of the first operation a second was performed for the 
removal of the fold of integuments, already so often referred to. This was 
accomplished by first rapidly excising the parts with a strong pair of scis- 
sors nearly down to the depth of their union > and then cautiously dissecting 



1842.] Meiiaue![ on Hypospadias and Epispadias. 55 

away the remaining portions, taking care to leave no more integuments than 
sufficient to render the organ comely. The latter step of this operation was 
executed with less ease than might have been imagined, as it required great 
care, and was accomplished amidst torrents of blood pouring from four or 
five pretty large arteries, two of which required the ligature. As soon as 
the superfluous textures were dissected away the margins of the skin were 
carefully approximated, and confined by eight interrupted sutures. Over 
these, adhesive plasters applied around the penis were next used, and the 
whole supported by a narrow, soft bandage, put on just firmly enough to 
impart the necessary support to the under dressing. On the fourth day the 
wound was examined and redressed; and in two weeks the sutures were cut 
away, and the parts found to be firmly united and well. After this the only 
dressing used to the cicatrix (Fig. 3, a, b) was a strip of soft old linen spread 
with simple cerate, long enough to encircle the organ, and confined by a 
light bandage merely to prevent the abrasion of its delicate cuticle. 

The penis now presented a very natural appearance, and was fully two 
inches in length during the non-erected state, measuring from the scrotum* 
The glans, too, which had lost its sensibility from 
the moment the intermediate skin between it and 
the stump was divided, had in some slight degree 
at this period recovered its feeling, and it manifested 
a decided erectile blush, and some expansion from 
friction; or, from compression of the root of the 
organ: during venereal excitation, these changes 
were also to be perceived in it. In the erected 
state, the penis measured nearly four inches and a 
half in length, and presented in all respects a most natural appearance; and,, 
doubtless, will be found perfectly useful, after the contracted portion of the 
urethra shall have been restored to its proper condition, and the perinaeal 
opening closed. 

It was judged advisable to defer the operations for restoring the urethra 
to its pervious and proper condition, as well as for closing the preternatural 
opening in the perina^um permanently, until the parts previously operated 
upon should entirely recover from all inflammatory tenderness, and become 
firm and healthy. In accordance with this view several months elapsed 
after the removal of the tegumentary intermedium, before we attempted the 
operations designed to open the contracted portion of the urethra, and to 
close the opening of the perinaeum permanently. The case at length being 
favourable for the execution of this operation, first exposing the part to a 
strong light, we commenced by placing a probe curved near its extremity,. 
in the perinaeal opening, with the point firmly pressed in the direction of the 
glans into the cul de sac at the termination of the inferior urethra, which was 
then passed into the hands of an assistant to be held steadily. The penis 
was next elevated so as to form nearly a light angle with the abdominal 




56 Mettauer on Hypospadias and Epispadias. [July 

wall, and firmly held with the left hand embracing it low down, with the 
middle finger placed along, and supporting the rapheal line corresponding 
with the passage to be opened. In this situation a h)ng trocar was intro- 
duced at the meatus, and carried quite down through the anterior, or supe- 
rior urethra to its cul de sac, with the concavity to the symphisis, and the 
lancet retracted within the canula, held and directed with the right hand. 
The blunt extremity of the canula w as now pressed firmly into the bottom 
of the cul de sac; and after giving it the proper direction, the lancet was pro- 
jected from its concealment about five lines and immediately retracted within 
the canula. The canula was now pressed onward so as to fill the part 
incised quite to the bottom, and in this situation the lancet was again pro- 
jected as already described. In this manner the operation was repeated 
until the extremity of the canula entered the inferior portion of the urethra 
announced by the displacement of the probe from its cul de sac. The trocar 
was then withdrawn, the lancet having been previously retracted within its 
canula, and the entire passage from the meatus to the bladder immediately 
filled with a gum elastic tube of proper size. Care was taken not to carry 
the tube more than the depth of its proximal aperture into the bladder, so 
that the urine might be completely decanted from its cavity. 

We next touched every part of the opening of the perinseum, from its ex- 
ternal margins quite down to the tube, with a delicate stick of nitras argenti, 
so as to cauterize effectually; and after the eschars were carefully scraped off 
with a small, delicate scalpel so as to expose a new denuded surface, the 
opening was closed with two points of the interrupted suture, inserted from 
within outwardly down to the tube, and fully eight lines from the margins. 
Thus inserted, the threads when tightened and tied, closed the opening com- 
pletely. A compress was now placed upon the sutures supported by a T 
bandage applied with moderate firmness. Finally, the tube was guarded 
with a stopper, and confined as already advised, to prevent its displacement 
from the urethra. We directed that the bladder should be evacuated every 
second or third hour, to guard as far as possible against the passage of urine 
around the tube; an accident which might occur in the event of a large accu- 
mulation of water in the bladder taking place. 

In this situation the case was suffered to remain five days, durino- which 
time we found it necessary to administer two mild cathartics, and to confine 
the patient in bed, and to a very abstemious diet. At this period the tube 
was carefully removed, and the parts found to be in a most favourable condi- 
tion for a speedy and perfect cure. The urethra suppurated freely, but not 
too much so; and the margins of the perinaeal opening seemed firmly united. 
The sutures were not cut away, as they seemed yet firm. A fresh tube was 
introduced without the wire, guarded and secured as the first, and was kept 
in the passage three days more. After this the tube was only introduced 
during urination, to prevent, if possible, any stress from the flow of water 
along the urethra upon the newly closed permseal opening. On the twelfth 



1842.] M'Naughton on Diseases of the Brain and Spinal Marrow. 57 

day the sutures were cut away and the margins of the opening found to be 
firmly and perfectly united. 

We advised tlie patient to introduce a tube or bougie .through the newly 
formed passage, at least once a day for a year, and after that period to em- 
ploy it occasionally to prevent its contraction. 

The urethra was now free from all tenderness, and transmitted the urine 
from the bladder in a bold and full stream. 

Thus modified, there is litde doubt but the penis will prove useful for all 
purposes; and compensate the young man for the pain and suffering he 
endured from the different operations performed for his relief. 

Prince Edward C. H., Va., April 21, 1842. 



Art. IV. — Cases of Disease of the Brain and Spinal Marroiv. By James 
M'Naughton, M. D., Professor of Theory and Practice of Medicine in 
the Albany Medical College. 

No diseases have of late years engaged the attention of the medical pro- 
fession more than those of the brain and spinal marrow. Much yet remains 
to be done before the obscurity in which these diseases are involved is 
removed. The following cases are deemed of sufficient interest to deserve 
to be put on record, as examples of some of the most formidable of their 
class. 

Case I. Mr. F. F. was a professional gentleman of high character and 
respectability, who had enjoyed good health until the autumn of 1837. 
During the cholera in 1832 he was a good deal indisposed, whether from 
the epidemic influence, or merely from the anxiety which most people felt 
during that gloomy period, it would be difficult to determine. He then got 
into the habit of taking medicine to ward off an attack of the disease; but, 
unfortunately, he continued to tamper with medicines after the cessation of 
the epidemic, to the injury of his digestive organs. 

About the beginning of October, 1837, while engaged in some perplexing 
business, which required his occasional absence from town, he returned 
home, labouring under what appeared to be a common cold, namely, chilli- 
ness, headache, some oppression of breathing, cough, white tongue, and 
derangement of the digestive organs. In the course of a few days, he be- 
came so much worse that I was called in. I found his pulse under 50 in a 
minute, skin cool, tongue much loaded with a whitish, slimy mucus; coun- 



58 M'Naughton on Diseases of the Brain and Spinal Marroiu. [July 

tenance loaded and heavy; the right eye suffused and cloudy. He also com- 
plained of headache, and was slightly delirious. Regarding the case as one 
of congestive fever, I attempted to draw blood from the arm; but the circu- 
lation was so languid that very little was discharged. The patient lay in a 
drowsy, torpid state, but when roused could give rational answers to ques- 
tions. Sinapisms to the extremities and abdomen, friction over the integu- 
ments, and an epispastic to the neck, were directed, with a view of causing 
a freer determination of blood to the surface, and of relieving the internal 
organs from oppression. These answering the purpose but imperfectly, it 
was thought that an emetic, by unloading the stomach, and by its influence 
on the abdominal and other secretions, would answer a good purpose. A 
full dose of ipecacuanha, in combination with five grains of sulphate of zinc, 
was directed to be administered, if reaction was not soon re-established. 

In less than an hour I was sent for in great haste. I was informed that 
my patient was vomiting blood very profusely. Upon reaching the house, 
I ascertained that half a chamber-potful of black looking stuff had been 
thrown off the stomach. By candlelight I could not well determine the 
true character of what was brought up; but it did not seem to be blood, 
but a vitiated biliary secretion. Such proved to be the case when I ex- 
amined it by daylight. The emetic had not been exhibited, consequently 
the vomitmg was spontaneous. The stupor and oppression were relieved by 
the vomiting, which was, therefore, for a while promoted by drinking warm 
water. Afterwards the bowels were opened by a purgative enema; and when 
the stomach became sufficiently settled to retain medicine, a full dose of 
calomel was given, and followed in a few hours by a suflacient dose of cas- 
tor oil, to procure several free evacuations. These for several days conti- 
nued to have the same general character with the discharges from the sto- 
mach, dark and pitchy. In the course of a week, however, the evacuations, 
by the use of gentle purgatives, acquired a natural appearance, the tongue 
became clean, and the patient gradually recovered his health, without any 
occurrence worthy of record. During the early part of the attack, there 
was a retention of urine, so that the catheter had to be used for more than 
a week, to prevent injurious accumulation in the bladder. 

During the winter of 1837-38, he enjoyed a tolerably good share of 
health, and attended to his professional duties. In March 1838, business 
required his going to New York. The weather, as often happens in that 
inclement month, was cold and wet, and he suffered from exposure, both 
on the voyage down the river, and during his stay in the city. He returned 
to Albany, complaining of headache, pains about the chest and shoulders, 
cough, and general indisposition. On the 1st of April he had a second 
attack of vomiting of black matter, like that of the preceding year, attended 
by symptoms so exactly similar, that it would be useless to repeat them. 
The same general plan of treatment was pursued as on the former occasion, 
^^(J with sirflil3r result?, ej^cept th^t his recovery was much slower, The 



1842.] M'Naughton on Diseases of the Brain and Spinal Marrow. 59 

stupor, low delirium, slow, languid pulse, attended with dark discharges 
from the bowels and retention of urine, continued for more than a week. 
All the symptoms, however, gradually yielded, and I anticipated as happy 
a termination as on the first attack. In about three weeks the patient was 
able to sit up and get dressed; his tongue became tolerably clean; his appe- 
tite orood; his mind clear and cheerful. There seemed no reason to doubt of 
his entire recovery. 

His strength, however, did not return so fast as might be expected from 
his good appetite, and the quantity of food he took with apparent relish. 
His pulse continued slower and softer than natural, and the temperature of 
his skin remained low. His walk was peculiarly unsteady and tottering, 
but he made little complaint of uneasiness in the head, and not much even 
of dizziness. When his arms were in a dependent position, the hands felt 
cold and clammy, and the blood seemed stagnant in the capillaries, giving 
the skin a dark purplish hue, leaving a white streak when the finger was 
drawn along the skin, not unlike that produced in the blue stage of the Asi- 
atic cholera. In this general condition he remained for two or three weeks, 
rather losing than gaining in muscular strength. One day when I called to 
see him, I found him sitting in an arm chair, his forearm and hands hanging 
over the arms of the chair. I asked him to raise his hand that I might 
examine his pulse; when I ascertained, to my surprise, that he had not the 
power to do so. On my former visits, he was either in bed, or had his 
arms supported, so that I did not, from his general appearance and symp- 
toms, suspect that there was any tendency to palsy, although his wife had 
repeatedly told me that her husband was every day becoming weaker instead 
of stronger. I did not give heed to this warning, believing it to be nothing 
more than the impatience not unfrequently observed among the friends of 
the sick. The warning, however, was well-timed; for, upon closer inquiry, 
I found out that my patient had in point of fact lost, to a considerable 
degree, the power of voluntary motion of both the upper and lower extremi- 
ties, attended with some perversion of sensation, but no actual pain. Ex- 
cepting that the patient was more irascible than usual, there was no marked 
disturbance of the mental faculties, no headache, and no pain or tenderness 
on pressure along the spine. 

I therefore considered the palsy the effect of the long continued conges- 
tion of blood in the vessels of the brain and spinal marrow, connected, per- 
haps, with more or less serous effusion within the cranium. I expected 
that it would gradually yield under proper treatment, as the injured organs 
recovered their wonted condition. 

As the history of the case indicated at least severe functional disturb- 
ance of the liver and associated organs, a mild mercurial course seemed to 
be indicated. The patient was accordingly put upon a course of blue pills, 
laxatives, vegetable tonics, and nutritive diet, for the improvement of the 
general health, while cupping on the nape of the neck and along the spine, 



60 M'Naughtoii on Diseases of the Brain and Spinal Marrow, [July 

followed by blisters, issues, &c., were had recourse to for the purpose of 
acting more immediately on the nervous centres. Under this treatment he 
gradually improved, so as to be able to walk about the room, with the aid of 
a cane, or the arm of an assistant. While in this condition, some officious 
friend put into his hand a pamphlet, showing the almost miraculous effects 
of electricity in cases like his. Nothing would satisfy his friends but a trial 
of that potent agent. It was tried, contrary to my advice, for about a week, 
when, seeing that it was doing harm, I remonstrated against its further 
employment, and it was discontinued. 

After this, it was thought best to take him into the country during the 
hot weather of July and August. After spending a few weeks in the coun- 
try, he returned to town, rather injured than benefited by the excursion. 
He had suffered several times from imprudent exposure to currents of damp 
air during his absence. 

In October he made a journey to Boston, and returned by way of New 
York. This excursion, like the visit to the country, proved of no benefit 
to him. My duties at the College of Physicians and Surgeons of the 
Western District, required my absence from Albany, from the 1st Nov. 
1838 to the 20th of January, during which time my patient had several ill 
turns of a comatose character, bordering on apoplexy. On my return, I 
resumed charge of the case, directed attention to the state of the digestive 
organs, had recourse to cuppings and blisters along the spine, an issue in 
the nape of the neck, and stimulating frictions to the limbs and trunk of 
the body. 

Under this treatment he again improved, began to acquire the use of his 
limbs, could walk the room with a little assistance, and in good weather 
was able to ride out. We again began to hope for a favourable result; but 
this encouraging state of things did not last long. About the beginning of 
May, 1839, he began to complain of what he regarded as rheumatic pains 
in the joints. The pains were at first confined to the neck, elbows, knees 
and groins. The pains came on in paroxysms, attended with spasmodic 
contractions of the limbs. At first the contractions ceased with the parox- 
ysm of pain, but by degrees the contractions became permanent — subject, 
however, to occasional aggravation. Any attempt to extend the limbs forci- 
bly, caused immediate spasmodic contraction with excruciating pain. Both 
the upper and lower extremities became permanently contracted; but the 
lower to a greater degree than the upper, and attended with more pain. 
He could use his fingers, to a certain extent, during the whole course of 
the disease, but had little power over the larger joints. The knees were 
drawn up towards the abdomen, and the legs bent upon the thighs, so that 
the heel rested firmly upon the soft parts covering the tuber ischii. Any 
attempt to extend the limb caused pain, and was immediately followed by a 
forcible retraction of it to its former position. 

The surface of the body during the early stages of the contractions of 



1842.] M^Naughton on Diseases of the Brain and Spinal Marrow. 61 

the limbs was morbidly sensitive to the touch; so much so that the mere 
approach of a person to the patient frequently caused him to cry out from 
fear of being hurt. He appeared to suffer excruciating agony whenever it 
became necessary to move him. 

The case remained for several months very much in this state, in spite 
of every effort made for his i-elief, with very little amendment, except a 
gradual diminution of pain. I need not enumerate all the means employed. 
They were those generally used in cases of Myelitis, with the addition 
occasionally of other means to obviate derangements occurring in the func- 
tions of other organs in so protracted a disease. 

After the regular faculty had in a measure given up all hope of a cure, a 
German empiric tried, for several months, the effects of warm baths, and 
various external and internal applications, but without any permanent ad- 
vantage. 

The patient became gradually emaciated; cough and bronchitis came on, 
attended with fever of the hectic type. Towards the close of December, 
1840, the fever became more severe, mild delirium set in, and on the even- 
ing of the 28th of January, 1841, the aifficted sufferer breathed his last in 
the 41st year of his age. 

In the whole course of a long and extensive practice, I have not seen a 
case in all respects so lamentable, or so well calculated to excite the sym- 
pathy of every feeling heart. The patient, a gentleman of fine talents, in 
the prime of life, in the highest position in society, and surrounded by every 
thing that could make life desirable, was cut off for several weary years 
from all his enjoyments, and at last for several months, stretched as it were 
on the rack, a helpless, hopeless sufferer. If death be ever welcome, it 
must truly be in such a case. During the greater part of this severe and 
protracted illness, the digestive organs performed their functions tolerably 
well, and the mental operations, with occasional exceptions of no long 
duration, were not seriously impaired. During the last year of the patient's 
life he had complete amaurosis of the right eye. The condition of this eye 
before the state of amaurosis came on, corresponded with the several exa- 
cerbations of the disease, being uniformly inflamed and turbid whenever 
there existed any considerable febrile disturbance of the system, and subsid- 
ing with the febrile symptoms. 

Having requested permission to have the body examined, leave was 
granted. 

Post mortem appearances of the brain and spinal canal. 

At 11 o'clock A. M., Jan. 21st, 1842, proceeded to examine the body in 
the presence of Professors Hun and Armsby of the Albany Medical College, 
my brother Dr. I. M'Naughton, and several medical students and friends of 
the deceased. 

The roof of the cranium was removed in the usual manner by the saw. 

Dura mater. The dura mater was more firmly adherent to the cranium 
No. VII.— July, 1842. 6 



62 M'Naughton on Diseases of the Brain and Spinal Marrow. [July 

than is usual in adults. The os frontis was thickened, particularly on its 
inner table, from a little above the superciliary ridge to the coronal suture. 
Numerous spiculae of bone on the inner table, some of which penetrated 
between the fibres of the dura mater. On the left side of the mesial line a 
portion of dura mater of the size of a finger-nail absorbed, corresponding to 
the situation of a bony prominence on the inner table of the skull. No 
other morbid appearance on dura mater. 

Arachnoid. Arachnoid opaque over the hemispheres, presenting nume- 
rous pale granulations for some distance on each side of longitudinal sinus. 
Copious effusion of serum between arachnoid and pia mater, filling the fur- 
rows between the convolutions. Pia mater. No unusual vascularity, or 
turgescence of capillaries. No morbid appearance of note. 

Hemispheres. General appearance healthy; consistency firm; convolu- 
tions uncommonly deep. In the fore part of the right hemisphere above 
the anterior eornu of the lateral ventricle was observed what seemed to be 
the vestige of a small cavity. No morbid appearances seen in the interior 
of other parts of the brain or cerebellum. 

Under surface of the brain and cerebellum. Pia mater and arachnoid of 
the same appearance as on the upper surface, excepting that there were no 
granular bodies on the arachnoid. The same kind of clear serum between 
the membranes and in the intervals between the convolutions. 

Optic nerve of the right side from the eye to the optic commissure smaller, 
rounder and firmer than that of the left; no perceptible difference in the 
optic tracts behind the commissure. The optic thalamus of the left side on 
its outer and back part softer than that of the right. Tuber annulare firmer 
than usual; corpora pyramidalia and olivaria very prominent and firm; me- 
dulla oblongata very firm. 

Spinal marrow. From the foramen magnum to the first or second dorsal 
vertebra all the membranes of the spinal marrow firmly united, and much 
thickened; dura mater united to the posterior common ligament of the spine 
throughout the cervical region. The marrow in the same region very soft; 
on its back part semifluid. From the second dorsal vertebra to the lower 
end of the spinal canal the sheath of the spinal marrow was distended with 
a very clear serum. The lower end of the spinal marrow firmer than usual, 
and together with the cauda equina of a beautiful roseate hue, but without 
distinct vessels. No appearance of flakes of coagulable lymph on the mem- 
branes of the brain or marrow, or in the serum — nothing that indicated 
recent acute inflammation. 

From the permission granted we did not feel at liberty to examine the 
thoracic and abdominal viscera. 

The contraction of the lower extremities was so excessive that we were 
obliged to divide the hamstrings to get the body into the coffin. 

Case II. Mr. B., a medical student, some time in the month of November 



1842.] M'Naughton on Diseases of the Brain and Spinal Marroio. 63 

last, when returning from the college to his lodgings, fell in the street and 
hurt himself. He complained particularly of the "jar" his head had re- 
ceived; but I could not learn from himself that his head had actually struck 
the ground, although his companions were of the opinion, from what he had 
told them at the time, that it had. From that time he complained of not 
feeling right about the head; was observed to be rather dull and low-spirited 
at times, so that he was teased about being homesick. He continued, how- 
ever, to attend lectures with tolerable regularity until the middle of Febru- 
ary. At that time he went to the neighbouring city of Schenectady to 
attend a funeral. The weather was cold and disagreeable, and he thought 
that he caught cold while standing in the street before the procession began 
to move. On the morning of the 17lh of February he returned to Albany, 
complaining of not feeling well. At 12 o'clock A. M, of the 18th, he was 
seized with a severe chill, like the cold stage of an intermittent, which was 
followed by a paroxysm of high fever and much headache. His room com- 
panion, a medical student, gave him an emetic, and followed it in the morn- 
ing by a cathartic. By these means the fever was relieved, so that he 
acknowledged himself much better next day. On the morning of the 19th, 
at the same hour with the preceding attack, he had a second chill followed 
by fever. His room mate inferred from the recurrence of the chill at the 
same hour that the disease was a quotidian intermittent, and therefore 
thought the case one in which bleeding in the cold stage would be proper. 
He accordingly bled him during the chill, but did not take much blood 
away. On the 20th he had another slight chill, but it did not come on until 
7 o'clock in the morning. At this time the young man's friend became 
uneasy about him, and I was requested to visit him. I called in the fore- 
noon. When I saw him his pulse was full but not hard, and not over 
90 in a minute; tongue white; skin warm and moist; countenance full and 
flushed; but the flush variable. The breathing was rather slow, and the 
speech rather more slow and deliberate than usual with him; the voice 
hoarse, with a tendency to cough. He complained of headache, but it was 
not severe. He could not sit up in bed on account of a sense of weakness 
or faintness which he experienced when he made the attempt. He did not 
appear to suffer much from the admission of light into his room, nor from 
the ordinary noises in the street, but the conjunctiva of the eyes was some- 
what red. The young man had a fair complexion, and a skin of feminine 
delicacy and softness. 

Each paroxysm of fever was distinctly marked by the three stages of an 
ordinary intermittent — cold, hot, and sweating. At the time of my visit 
there was no delirium, and I could not learn that there had been any worth 
speaking of. The symptom.s did not seem to indicate the necessity of any 
very active treatment. I merely directed that the bowels should be kept 
open, and that antimonials should be given while the skin continued hot and 



64 M'Naughton on Diseases of the Brain and Spinal Marrow, [July 

dry, and gave suitable instructions in relation to diet, and the general naa- 
nagement of the case. 

From this time to the 27th he continued to improve; had no return of 
chills; his hoarseness and cough left him; his tongue became clean and his 
appetite returned. "When I saw him on the 27tli he was sitting up, looking 
pale and v/eak, but was eating his dinner apparently with a good appetite. 
He made no more complaint of his head than is usual with persons reco- 
vering from an acute disease. I considered him convalescent, 'and hoped 
that in a short time he would be able to return home to his friends in the 
country. 

I heard no more of him until the afternoon of the 2d of March, when I 
was sent for in great haste. I was so situated at the time that I could not 
visit him, but directed that if there was any thing urgent in the case another 
physician should be called in. Dr. Peter Van Beuren, living within a few 
doors from him, was called in. I was not able to see the patient until the 
morning of the .3d of March. The family in which he boarded informed 
me that he had been apparently getting better from the time I last visited 
him; that he came down stairs from the third story where his room was 
into the second, and spent some time there. On the 2d of March he came 
down into the first or lower story, in which the family lived, and took din- 
ner with them. After dinner he complained of headache, and about four P. 
M., had a violent epileptic fit, during which he bit his tongue severely. Dr. 
Van Beuren bled him freely, applied cold to the head, and used other suita- 
ble means to guard against undue determination of blood to the head. The 
fits returned three or four times in the course of the evening and night; 
When I saw him next day his face was flushed, and the expression of his 
countenance changed; his pulse full and strong, but not frequent. His 
speech was slow, and his mental operations evidently sluggish. The fits 
did not return after the first night. 

The attending physician treated the case with judgment and energy; by 
further bleedings, both general and topical, by cold applications to the head, 
blisters to the neck and forehead, purgatives, &;c., but with no advantage to 
the patient. He continued gradually to sink — the breathing becoming more 
slow, the mind more torpid, and the pulse irregular until he died, without a 
struggle, at five o'clock on the morning of the 10th of March. 

Post mortem examination. — Twelve hours after death, having with some 
difficulty obtained permission to examine the body, before its removal into 
the country, where the family of the deceased resided, I proceeded to the 
examination, assisted by my colleague. Professor Hun, Dr. Van Beuren, and 
several medical students. Dr. Hun made minutes of the dissection at the 
time. The upper part of the cranium was removed in the usual way. The 
membranes of the brain were then examined over the hemispheres, and the 
brain and cerebellum then removed from their situation, having first divided 
the medulla oblongata as low down as possible. 



1842.] M'Nanghton on Diseases of the Brain and Spinal Marrow. 65 

Dura mater slightly injected. 

Arachnoid smooth, shining, and remarkably dry in its whole extent. 

Pia mater, no unusual turgescence or vascularity. No serum between 
the membranes. 

Left hemisphere. — Two abscesses three-fourths of an inch in diameter, 
about an inch below the surface, at the upper and fore part of the hemi- 
sphere, above the lateral ventricle, near the mesial line. Each abscess was 
surrounded by an indurated cyst, with softening of the medullary substance 
around, particularly above the abscesses. Another abscess larger than the 
above-mentioned, situated below the lateral ventricle in the middle lobe, 
extending to its surface, with absorption or disorganization of the pia mater 
and arachnoid membranes, of half an inch in diameter. The dura mater at 
the corresponding point was sound. There was extensive softening of the 
brain all around this abscess. 

Right hemisphere. — An abscess similar to those on the left side and 
nearly opposite to them, but situated on a level with the corpus callosum, 
and involving Solly's commissure. This abscess had a process extending 
towards the lateral ventricle, but did not penetrate into it. Both the cortical 
and medullary substances were greatly softened to a considerable distance 
around this abscess. The corpus callosum, too, in the vicinity of the ab- 
scess, was uncommonly soft. Another abscess beneath the hippocampi 
extending into the middle lobe. Two abscesses at the base of the posterior 
lobe, with general softening of the entire lobe. 

The lateral ventricles were firmer and more contracted than usual, and 
had hardly any serum in them. The choroid plexus and velum interpositmn 
exhibited no unusual turgescence, or evidence of previous excitement. The 
brain in general softer than natural both in its white and its grey matter. 
Corpora striata, optic thalami, pons varolii, crura cerebri et cerebelli, and 
cerebellum itself apparently sound. The pus in the abscesses was well 
formed, had a slightly greenish tint, and exhaled an offensive odour. Each 
of the abscesses was surrounded by an indurated cyst, and the brain around 
the cysts was so soft that the cysts could be removed entire by the forceps. 
There was none of the vascularity or capillary turgescence, which usually 
indicate recent acute inflammation around the abscesses. 

In this case the pain in the head had never been very severe, and there 
was not much delirium at any stage. Even in the last there was little more 
than torpor of the mental faculties. At my last visit, the night before he 
died, he answered all my questions distinctly and rationally. 

The article has already extended further than will, perhaps, be agreeable 
to readers of the Journal. I therefore forbear to make any further remarks 
on the above cases, at least for the present. I have endeavoured to give a 
faithful account of the cases, and leave it to others to decide how far the 
morbid appearances corresponded in kind and degree with the symptoms of 
the disease as given in the foregoing histories^ 



66 



Mutter's Cases of Deformity from Burns, 



[July 



Art. V. — Cases of Deformity from Burns^ relieved by Operation. By 
Tiios. D. Mutter, M« D., Professor of Surgery in Jefferson Medical 
College, Philad., &c. 

In the month of January, 1841, I was requested to attend Miss A, T. of 
Chesterfield township, New Jersey, who h'c twenty -three years had endured 
much mental as well as physical inconvenience from the effects of a burn 
■which occurred when she was five years old, and involved the face, throat, 
and upper part of the thorax in front. The following extract from her his- 
tory of the case, will explain the nature of the accident, as well as 'the treat- 
ment to which she had been subjected before I saw her: — " I received a 
burn when five years old by my clothes taking fire. My grandmother being 
a great doetress nursed me, until prevented by indisposition; and as they 
wished me to remain in as comfortable a position as possible, my life being 
entirely despaired of by the family, medical aid was not called in. Dr. 
Burns, a neighbouring physician, hearing of the circumstances, could not 
refrain from calling to see me; he called twice as a friend, and was then for- 
bidden to come again until sent for, which was never done. When about 
11 years of age, an attempt was made by Dr. Cook of Bordentown, to afford 
some relief. Being young, I was much alarmed, and opposed him. My 
near relations, being unwilling to see me suffer, united with me; and he was 
obliged to desist before completing his design. I therefore did not experi- 
ence any relief, and have been unable to throw my heml to the left side, or 



Fig. 1. 




backwards, or to close 
my mouth for more 
than a few seconds at 
a time for 23 years. 
My right eye was also 
dranm doiun some dis- 
tance beloio the other, 
and when I endea- 
voured to turn my he^d, 
it was entirely closed. 
My condition has been 
most humiliating, and 
made life a burthen; but 
having good health, I 
strove to reconcile my- 
self to my hard lot!" 
In addition to the symp- 
toms so vividly de- 
scribed, I found the 



1842.] Mutter's Cases of Deformity from Burns. 67 

angles of the lower jaw altered, and the incisor teeth nearly horizontal, (as 
is seen in cases of chronic hypertrophy of the tongue,) by the pressure of the 
tongue, which organ, in consequence of the inability of the patient to close 
the mouth, was always visible, and indeed protruded, when she was silent. 
The clavicle on the right side was also so completely embedded in the 
cicatrix, that it could scarcely be felt, and there was no external indication 
of its location. The chin from the shortness of the bands was drawn down 
to within one inch and a half of the top of the sternum, and the head con- 
sequently inclined very much. The space between the chin and sternum 
was also filled up by the cicatrix, so that no depression existed in front of her 
neck. Fig. 1, which represents her full face, affords a very correct idea 
of her af)pearance. After carefully examining the case, and fully explaining 
to the patient and her friends the inutility of any of the usual operations for 
such deformities, I proposed to them one entirely different in its principle, 
which although severe, as well as somewhat hazardous, promised partial, if 
not entire relief. To this my patient readily assented, declaring that death 
were preferable to a life of such misery as hers. In conformity with her 
wishes, I at once placed her on a preparatory treatment, and on the 12th of 
January, performed the operation to be described, assisted by Drs. Noble 
and Pierce, and in the presence of Messrs. Ward, Ducachet, Mason and 
Egan, medical students. 

The patient being placed in a strong light, and seated on a low chair, her 
head was thrown back as far as possible, and sustained in this position by 
an assistant. 

Seating myself in front, I began the operation by making an incision 
which commenced on the outside of the cicatrix in sound skin, and passed 
across the throat into sound skin on the opposite side. This penetrated 
merely through the integuments, and was made as near the centre of the 
cicatrix as possible. It was therefore about three quarters of an inch above 
the top of the sternum, and of course in the most vital part of the neck. My 
object in making it so low down was to get at the attachments of the sterno- 
cleido-mastoid muscles, which in consequence of the long flexion of the head, 
were not more than three inches in length, and required on one side com- 
plete, and on the other partial division, before the head could be raised. 
The integuments having been thus divided, I next carefully dissected 
through the cicatrix until I reached the fascia superficialis colli, which I could 
readily detect, and then going on still deeper, I exposed the sterno-cleido- 
mastoid muscle of the right side, and passing a director under it, as low 
down as possible, divided both its attachments. This enabled me to raise 
the head an inch or two; but finding that it was still kept down by the 
sterno-cleido-mastoid of the left side, I divided the sternal attachment of this 
muscle, and was much gratified to find that the head could at once be placed 
in its proper position, the clavicular attachment of the muscle offering little or 
no resistance. A most shocking wound six inches in length hy five and a 



68 



Mutter's Cases of Deformity from Burns. 



[July 



•'^^ff- ^' half in width., was 

thus made, and yet 
there was scarce- 
ly any hemorrhage; 
three or four ves- 
sels only requiring 
the ligature. (See 
Fig. 2.) 

The next step in 
the operation con- 
sisted in the detach- 
ment of a flap of 
sound skin with 
which this chasm 
could be filled; for I 
knew very well, that 
if permitted to heal 
by granulation only, 
the patient, so far 
from being benefit- 
ed, would be made worse than before. To obtain this flap, I com- 
menced at the terminal extremity of the incision, and carrying the scalpel 
downivards and outwards over the deltoid muscle, dissected up an oval 




Fig. 3. 




piece of integument six 
inches and a half in 
length, by six in luidth, 
leaving it attached at 
the upper part of the 
neck, (see fig. 2.) This 
dissection was painful, 
butnotbloody, only one 
small vessel being open- 
ed. The flap thus de- 
tached was next brought 
round by making a 
half-turn in its pedicle, 
placed in the gap it was 
destined to fill, and care- 
fully attached by seve- 
ral twisted sutures, to 
the edges of the wound, 
^ (see fig. 3.) Several 
straps were then applied 
to support the sutures, 



1842.] M'dtter^s Cases of Deformity from Burns, 69 

but no other dressing was deemed advisable. The edges of the wound 
on the shoulder from which the flap had been removed, were next brought 
together by straps and sutures, and with the exception of its upper third, 
was completely covered in. A pledget of lint moistened with warm water 
was laid upon this raw surface, a bandage applied by which the head was 
carried backwards and maintained in this position, and the patient put to bed. 
The fortitude with which this truly severe operation was borne excited 
the admiration of all present. Scarcely a groan escaped the patient, nor 
was it necessary to give her more than a mouthful or two of wine and water 
during the whole period of its duration. 

Rest and quietude were enjoined, and the patient prohibited from taking 
any kind of nourishment, in order that adhesion or union by the first inten- 
tion might be accomplished. 

Jan. ISth. — Patient has passed a good night; slight acceleration of the 
pulse, but no fever; not much thirst, complains of stiffness in the neck, and 
pain in the back from lying in one position so long. Slight headache from 
the anodyne which it was deemed advisable to administer before the opera- 
tion. 

nth. — Much as yesterday; a little nervous, but no fever, no swelling or 
pain in the wound; some thirst and hunger, but willing to go another day 
without sustenance. 

15//i. — A little feverish; wound painful at one point, thirst intense, bow- 
els not opened; restless, and anxious; ordered an enema to be administered 
at once; and spoonfuls of cool barley water to be taken every hour or two. 

IQth. — Much better; enema operated well, fever gone; thirst less, skin 
moist; cheerful and in hope. 

I7th. — The same; took off straps and found the wound united along the 
edges, with the exception of here and there a point; a small pouch of pus 
at the most dependent part of the flap; patient rather restless under the 
dressing. 

Evacuated the pus through a small opening in its vicinity; took out some 
of the pins, reapplied the straps; dressed the shoulder with poultice of slip- 
pery elm; ordered a little mutton broth, and an enema of salt and water. 

It would be worse than needless to detail the daily symptoms and treat- 
ment from this time to the period at which the patient was enabled to move 
about, and enjoy the full benefit of the operation. 

It will be sufficient to state that no unfavourable symptom made its appear- 
ance, that union by the first intention took place throughout the entire 
wound with the exception of one small point which united by granulation, 
that the wound in the shoulder, except just over the acromion process, 
healed kindly; and that the patient, as her own words will testify, has been 
relieved of all or nearly all inconvenience. The following extract is from 
a letter received some time since. 

*' The comfort and satisfaction I feel, cannot be expressed; your exertions 



70 



Mutter's Cases of Deformity from Burns. 



[July 



in my behalf have been blessed far beyond my most sanguine expectations. 
You have set my head at liberty, so that I can turn it any ivay, at plea- 
sure, and without pain; you have relieved tlie drawing of my eye; and 
I am also enabled to close my mouth with comfort, a blessing that cannot be 
described!" 

In order to accomplish the closure of the mouth, the lower incisor teeth 
were straightened and one of them extracted by a dentist. The angles of 
the lower jaw have, in consequence of the change in the condition of the 
throat, regained in a great measure their proper shape, and the whole ap- 
pearance of the patient is so much altered that persons who saw her before 
the operation, scarcely recognize her as the same individual. I should have 
mentioned that one troublesome circumstance occurred which will serve as a 
lesson in all subsequent operations of a similar character. Although very 
careful to extend my incisions from beyond what I supposed was the extent 
of the cicatrix, I yet left a band of this tissue, certainly not thicker or wider 
than a small wire. This band contracted, and before the patient could be 
entirely relieved I was obliged to loosen it by making an incision in the 
sound skin below on the neck. 

To support the neck after the incision had healed, I gave the patient 
a stiff stock on which her chin rested, and this instrument also served to 
press the integuments back, by which the natural excavation or depth of the 

neck in front was readily 



{Tig. 4.) 




effected. This stock is of 
course no longer in use, and 
the motions of the head 
are perfect; although it was 
predicted that the antago- 
nism between the muscles 
on the front and back of the 
neck having been in a great 
degree destroyed by the sec- 
tion of the mastoids, these 
motions would necessarily 
never be acquired. (Fig. 
4, represents her as cured.) 
More than a twelvemonth 
has elapsed since the ope- 
ration was performed, and 
yet there is no contrac- 
tion in the flap, and the 
relief of the patient is com- 
plete. 



1842.] 



Mutter's Cases of Deformity from Burns. 



71 



Case II. In the month of June 1841, I was requested to visit Margaret 
Ann Henderson, aged 12 years, who when four years ohl had received a 
severe burn of the chest, throat, and lower part of the cheek from her clothes 
having taken fire. 



(Fig:. 5.) 




For nearly eight 
years she had been una- 
ble to turn her head to 
the left side, the lower 
lip was everted, and the 
chin drawn down nearly 
n contact with the ster- 
num, while the front of 
the throat presented the 
rough, reddish cicatrix 
represented in fig 5. 

This case was even 
more unfavourable than 
that of Miss A. T.; but 
till, with the view of 
rendering her condition 
somewhat more bear- 
able, I determined to 
perform the operation 
which had proved so suc- 
cessful in the latter case, 
but a few weeks be- 
fore; and accordingly 
on the 20th instant, 
assisted by Drs. 
Knox, Davis, E. 
Smith, and Marston, 
it was carried into 
execution. The op- 
erations were almost 
identical, with the 
exception that in the 
case of Miss Hender- 
son the section of the 
tendon of the sterno- 
cleido-mastoid on the 
right side only, was 
sufficient to allow the 
head to assume its 
natural position. 



72 



Mutter's Cases of Deformity from Burns. 



[July 



The after treatment was also the same, nor did any symptom calling for 
energetic measures make its appearance; all speaking, swallowing, or motions 
of the neck of any kind, were carefully avoided until the fourth day, when 
the pins were taken out, and the patient allowed animal broths. Fig. 6, 
represents her appearance five weeks after the operation, and up to the pre- 
sent date, March 21, she continues as well as at that period — the relief 
afTorded is therefore as permanent as it is decided. 



Case III. About the first of January 1842, I was requested to attend 
Charles McAlister, aged 9 years, for a deformity of the mouth and throat 
produced by a burn. As is generally the case, the injury was the result of 
his clothes having accidentally taken fire, and he had suffered from its incon- 
veniences for several years. 

Fig. 7. The appearance pre- 

sented by this boy is well 
shown in fig. 7. His 
mouth was kept perma- 
nently open, -^his incisor 
teeth were losing their 
perpendicular position, his 
chin was drawn to within 
an inch or two of the 
sternum, and a strong 
band of the " tissue of the 
cicatrix," passed along 
the centre of the throat 
from the chin to the ster- 
num. The motions of 
his head were of course 
very much impaired. 
The operation already de- 
scribed was performed be- 
ifore the medical class on 
the second Wednesday in January, and on the first Wednesday in February 
he was brought into the amphitheatre with scarcely a vestige of the deformity 
remaining, and the wound healed throughout with the exception of a small 
spot near the shoulder from which the flap had been removed, and which 
united by granulation. It was found unnecessary to divide the sterno-cleido- 
mastoid on either side. Here, in three iveeks time, a cure of a deformity 
hitherto considered hopeless, was effected, and during the whole treatment 
not a symptom calculated to excite the shghtest anxiety, made its appearance. 
It may be as well to remark that I had seen this boy several months before 
I had devised my operation, in consultation with a professional friend, and 
we both agreed in the opinion that the best operation was that in which an 




1842.] 



Mutter's Cases of Deformity from Burns. 



73 



attempt is made to loosen the cicatrix by making incisions in the adjacent 
Fig. 8. sound skin, and then 

dissecting up the cica- 
trix itself and separat- 
ing the edges of the 
wound in the sound 
part, allow the latter 
to heal by granulation. 
In other words, the 
operation in which the 
tissue of the cicatrix is 
displaced from its na- 
tural position and made 
to form adhesions with 
new parts. 

Although performed 
with the usual skill 
and accuracy of the 
accomplished surgeon 
under whose care the 
boy was placed, the 

operation failed, producing, it is true, some little relief, but leaving him in 

the condition described. 

A fourth case of this deformity has been treated, and with success, but as 

it resembles the others in almost every respect, it is needless to enter into its 

details. 




JRemarks. — Few subjects in surgery have excited more interest than the 
peculiarities of cicatrices resulting from burns, and the plans of treatment by 
which the deformities they occasion may be either alleviated or entirely 
removed. Much of the controversy originating in the different views promul- 
gated, may be traced to the fact that few have studied the subject in a pro- 
per manner; and great credit is due to Dupuytren, Delpech, Velpeau and 
Cooper, for the highly interesting, simple, and practical matter recently fur- 
nished by them — by the aid of which the confusion hitherto enveloping the 
pathology of this important lesion has been removed. In the investigation 
of this subject, with the view of determining the propriety of operations such 
as those reported, it is important to direct our attention to several points. 

1. The nature of the tissue to be divided or removed. — Although the 
*' tissue of the cicatrix,'''' as it is termed by Dupuytren, however produced, 
always presents certain characteristic peculiarities by which it may be distin- 
guished from any healthy or natural structure, it yet exhibits modifications 
induced either by the cause or the tissue involved. The cicatrix of a burn, 
for example, can always be readily distinguished from that caused by sharp 
No. VII.—JuLY, 1842. 7 



74 Mvittev^s Cases of Deformity from Burns. U^^Y 

instruments; and again both these from those resulting from cancers, ulcers, 
herpetic diseases, syphilis or scrofula. The cicatrix of an ulcer in mucous 
membrane, differs, too, from one taking place in the skin. 

Nearly all formations of this tissue, however, when dissected, present pretty 
much the same structure. We have in the first place a delicate cuticle, 
which may be detached by vesication or maceration. Beneath this inorganic 
tissue is a dense stratum composed of strong fibres, which cross each other 
at different angles, and are firmly bound together. This is the true " tissue 
of the cicatrix" of Dupuytren, and the "inodular tissue" of Delpech, be- 
tween which and the cuticle there is no deposite, as a general rule, of rete 
mucosum; hence the whiteness of cicatrices in the African. It contains no 
hair bulbs, nor sebaceous follicles, at least when the lesion is profound, and 
although furnished with both nerves and blood-vessels, is usually less per- 
fectly organized than the parts whose loss it supplies. 

Lying under this tissue we find a dense laminated substance composed of the 
original cellular substance, which binds the cicatrix down, and offers in many 
cases the chief obstacle to the success of our operations. This is especially the 
case in severe burns; and whenever such adhesions exist, we must anticipate 
and be prepared for most extensive dissection if an operation be attempted. 

Anotlier difficulty occasionally, though very rarely, presents itself in cases 
dependent upon burns — namely, the vascularity of the cicatrix. Whenever 
this tissue is red, sensitive, soft, and movable, we may fear hemorrhage; 
and this condition will therefore always render our prognosis, so far as 
loss of blood is concerned, more unfavourable than when the parts are pale, 
firm, inelastic, and adherent. 

2. The thickness or profundity of the cicatrix. — The depth to which 
the ulcer upon which the formation of the cicatrix is dependent extends, 
should always be considered in our investigation of the cas€, for the prog- 
nosis, iis well as the treatment turn chiefly upon this point. 

When the integument merely is involved, the cicatrix is for the most part 
elevated, thrown into bands, movable and soft, the fascia beneath not being 
contracted. The motions of the subjacent parts are also normal; and hence, 
although the deformity may be considerable, yet the positive inconvenience 
is comparatively slight. In such a case the prognosis is favourable, and 
the operation required much less severe than under other circumstances. 
When, on the other hand, not only the integument, but the superficial fascia, 
cellular tissue, and muscles are attached, the inodular tissue is irregular, 
dense, thrown into hard ridges, immovable or nearly so, and the parts which 
it unites are disturbed, displaced, or, as in the case of openings and cavities, 
obliterated, the prognosis is very unfavourable, and the operations indi- 
cated e;xtensive and severe. This condition must not be confounded with 
that contraction of the fascia superficialis sometimes accompanying cutane- 
ous burns, but often the result of other causes, many of which are inappre- 
ciable. For example, I have known the fascia of the palm of the hand gradu- 
ally harden, contract, become thicker, and eventually inelastic, thus causing a 



1842.] Wiiiex's Cases of Deformity from Burns, 75 

permanent closure of the hand, the skin covering it being perfectly soft and 
pliable, while the cause of this change of structure was too subtile to admit of 
detection. Certain varieties of club foot are produced in the same way. 

This contraction is also frequently brought about by keeping a part too 
long in one position, and it may result from chronic inflammation of parts 
either above or below the fascia. 

3. Location of cicatrix. — The location of the cicatrices will also mo- 
dify the prognosis and treatment. When vital or highly organized regions 
are involved, great caution must be exercised in the delivery of an opinion 
favourable to any attempt at relief by an operation; and when such a pro- 
cedure is deemed advisable, we should always warn our patient, as well as 
his friends, of the probable risk. In deep cicatrices of such parts, there is 
less danger of hemorrhage than one would imagine, and for the reason that 
during the inflammation which accompanied or preceded the healing of the 
ulcer, the blood-vessels, especially the veins, in the vicinity were obliterated 
and converted into fibrous cords; but we should always be prepared for some 
bleeding, as all the vessels are not included in this obliteration. 

4. Extent of cicatrix. -^The extent, too, of the cicatrix is a point deserv- 
ing attention. The wider and more extensive it is, the more diflicult will it 
be to efl^ect its removal. And we are hardly justified in the performance 
of an operation, unless there is an almost positive certainty of our obtaining 
a less deformed cicatrix than the one we wish to remove. 

Dupuytren gives some very excellent advice relative to extensive operat- 
ing on cicatrices: when, for instance, adhesions between the arm and thorax, 
or thigh and pelvis are to be divided, he cautions us not to complete the 
operation at once, but to proceed by fractions, and let the wound of one opera- 
tion heal before we undertake another. In this way we avoid the dangerous 
consequences which may follow so large a wound as would be requisite to 
separate the parts at once. The same rule is applicable to extensive callous 
prominences. 

Another good rule is, to be certain, before any operation is attempted, that 
the limb retained in a faulty position is not incapable of being brought into 
a better one; if anchylosis, alterations of articular surfaces, or atrophy of the 
member is present, no operation should be attempted. 

5. .^o-e of cicatrix. — The duration or age of this inodular tissue must 
also be taken into account. The advice of Dupuytren is, *' that no opera- 
tion should be attempted until several months or even years have elapsed 
since the healing of the wound!" He believes that we run great risk of 
exciting inflammation and ulceration in the part, and moreover, that inas- 
much as the disposition of the cicatrix to contract is not lost for a long 
period after its complete formation, we do no good by an operation, which 
may indeed excite in this disposition a new energy. The older the cicatrix, 
then, according to him, the better, so far as an operation is concerned. This 
advice is at variance with that of some other surgeons, but it is, nevertheless, 
as a general rule, the safest to adopt. Especially is this the case where the 



76 Mniiev's Cases of Deformity from Burns, [July 

inodular tissue is superficial, and curable by simple incisions, followed by 
extension and pressure sufficient to keep the edges of the wound separate 
from each other. There are instances, as for example, where the cicatrix 
is so situated as materially to interfere with the comfort and convenience of 
the patient, where it would be proper to deviate from this rule, and operate 
as soon as possible: but these are rare exceptions, and do not militate against 
the correctness of the general proposition. 

6. Peculiar deformity of cicatrix. — The poiver with which these cica- 
trices sometimes contract is well known to every surgeon, but is sometimes 
overlooked in the desire for an operation. Mr. Earle has known it suffi- 
cient to bring the shoulders towards one another by a partial absorption of 
the clavicles. He mentions another case, in which not only the whole head 
was bowed down towards the sternum, but the lower jaw curved downwards, 
so as only to admit of the last molar teeth coming in contact; the mouth 
being kept permanently open, and the direction of the incisor teeth so al- 
tered, that they projected nearly in a horizontal line. (This resembles very 
much the deformity in my own case No. 1.) Cruveilhier mentions a case 
in which the carpus was luxated from the radius by a cicatrix on the back 
of the hand; and I have in my possession a similar specimen, and another has 
been deposited in the museum of Jefferson College by Professor Pancoast. 

An almost endless list of deformities of this kind might be cited, but the 
examples given are sufficient; and I need hardly add, that in all such no 
ordinary operation will prove of the slightest benefit. 

When, therefore, the original shape and function of a part have been de- 
stroyed, we should never operate unless there is a prospect of relieving at 
least the deformity. There are cases in which we must be content with 
this, while the loss of the function is an evil for which there is no remedy. 

Diversified as are the deformities from burns, Dupuytren is of the opinion 
that they may all be referred to five classes: — 

1. Those in which the cicatrix is too narrow. 

2. Those in which it is too prominent. 

3. Those in which it has formed extensive adhesions. 

4. Those in which a cavity has been obliterated. 

5. Those in which organs or an organ has been destroyed. 

This classification has not been adopted by all, although to a certain 
extent it is correct. 

Operations. — It must be obvious that as the cicatrices present a great 
variety of shapes, occupy different positions, and penetrate to different 
depths, the operations for their removal must be modified to suit the case. 

1. Narroiv cicatrix — Incision. — Suppose, for instance, the deformity 
consists in the formation of a narrow band of inodular tissue, which either 
causes inconvenience from the motion of the parts being interfered with, or 
from its unsightliness — what operation is most likely to relieve it? Surgeons 
are divided on this point. While some recommend incision of the band, as 
performed by the ancients, others tell us that such attempts are almost, if 



1842.] MHiier^s Cases of Deformity from Sums, 77 

not always useless, and what is worse, that they even increase the difficulty, 
each incision in cicatrizing, shortening the band more and more. The latter 
view, though in the main correct, is rather too exclusive, for there are many 
examples of entire relief having been obtained by incision and pressure, re- 
ported by Dupuytren, Velpeau, Hourmann, Berard and others. Much 
depends on the duration of the case, and the depth to which the cicatrix 
extends. If of long standing, and sufficiently deep to involve the fascia 
superficialis, the probability is, that the operation will fail, owing, as Mr. 
Earle has clearly shown, to the contraction of the muscles which thus ac- 
quire a new sphere of action, and to the adhesions of the fascia. In recent 
and superficial cicatrices, however, the plan will answer, and in its execution 
there are three indications to be observed. 

1. The incisions are to be made at several points, and completely through 
the tissue; a scalpel or bistoury is the instrument to be employed. 

2. The parts are then to be separated from each other, and placed at 
once, if supple and yielding, in their natural position; if rigid, a slow and 
gradual extension is to be kept up by splints and bandages until our end is 
accomplished. 

3. Extension is to be kept up some time after the completion of the cica- 
trix, and if new fraena or bands form they must be divided. 

2. Prominent cicatrix — Excision. — When the cicatrix is too prominent, 
forming, as it sometimes does, a most shocking deformity, and often caus- 
ing neuralgic pains, there are several plans employed for its removal; and as 
there is rarely any unnatural contraction of the parts beneath, the elevation 
being almost entirely confined to the skin, all the operations in use are limit- 
ed in their extent to this tissue. The one most to be relied on is that pro- 
posed by Dupuytren, in which there are three things to be observed. 

1. The projecting point is to be sliced off on a level with the skin. 

2. The edges of the wound are to be kept apart by appropriate machinery. 

3. The surface of the wound is to be frequently cauterized with argent. 
nit., so as to keep it rather below the level of the integuments. 

Instead of slicing off the cicatrix, others, as Higginbottom, Cleghorn, &c. 
prefer the application of a caustic by which the prominence is sloughed out. 
The nit. of silver, the chloride of zinc, nitric acid, and arsenical paste have 
all been employed; but it is obvious that this process is more painful, more 
tedious, and more likely to leave a bad scar, than that recommended by 
Dupuytren, and should consequently be rejected. 

3. Extensive adhesions. — When the deformity consists in adhesions by 
which parts are approximated that should remain separated, or others sepa- 
rated that should remain in contact, numerous operations have been proposed. 

Dupuytren's practice was as follows: — 

1. After having divided the adhesions, he dissected them freely to beyond 
their origin. 

2. Then he drew the parts asunder. 

•7* 



78 



Mutter's Cases of Deformity from Burns, 



[July 



3. Methodical and constant pressure was maintained on the point whence 
the cicatrix must proceed, which is always at the angle of union of the 
parts. — [Clin. Chir. torn, ii, p. 69.) 

This plan succeeds in some cases, but very often fails. 

In consequence of this operation so frequently failing in the accomplish- 
ment of a cure. Sir James Earle, and Delpech of Montpellier, revived the 
operation of Hildanus, which consists in — 

1. Cutting out the cicatrix. 

2. In bringing the edges of the wound together so as to cover the raw 
surface from which the cicatrix was removed. 

3. In extending the part by splints and bandages, and keeping them in this 
condition while cicatrization was going on, and for some weeks afterwards. 

By this plan the contraction takes place in a lateral direction, and not in the 
long axis of the part upon which it is performed, and the cicatrix is soft, 
linear, movable, and as extensible as natural integument. This is a favourite 
operation with Brodie, James of Exeter, Hodgson, and many others, and 
whenever practicable is probably as good as any that can be devised; but 
where the cicatrix is broad, irregular, situated on the neck, or different parts 
of the face, it is obviously a method altogether improper. 

I have succeeded by slightly modifying this operation in curing a very 
extensive cicatrix, involving the arm and forearm, by which the whole mem- 
ber was rendered useless. After cutting out the cicatrix, as advised by Hil- 
danus, I found it impossible to draw the edges of the wound over the raw 
surface, and it at once occurred to me that the only method by which I 
could secure success would be that which I have frequently resorted to in 
the operation for cleft palate, when there was difficulty in approximating 
the edges of the cleft, and 
which consists in making 
lateral incisions at some 
distance from the edges of 
the tissue to be displaced.* 
Doing this, and then draw- 
ing the wound together, I 
covered the raw surface per- 
fectly; and then dressing the 
two lateral wounds with 
warm water dressing, made 
them unite by granulation. 
The operation succeeded 
most beautifully, and may 
be resorted to in many simi- 
lar cases. 





[This is the same as the urethro-plastic operation practised by DiefFenbach; and of 
which there is a description and figure in the British and Foreign Medical Review, for 
April 1839, p. 413.J 



1842.] Miiiiex's Cases of Deformity from Burns* 79 

A plan, the principle of which was clearly recognized by Celsus, has been 
put into execution by my friends, Drs. J. Rhea Barton, and G. W. Norris, 
and also by myself, in extensive cicatrices about the neck, without, how- 
ever, deriving much benefit from its employment. The operation consists 
in — 

1. Making an incision through the integuments at some distance from the 
origin of the cicatrix, in other words, in perfectly sound skin. 

2. In dissecting up the skin and cicatrix as far as possible, without mak- 
ing any new incisions in the skin itself. 

3. In the separation of the divided parts, so that the cicatrix slides from 
its original position, leaving a raw surface to heal by granulation. The ope- 
ration is severe, and though sometimes useful, is not much to be relied on in 
cases of extensive contraction. 

The operation, which of all others, is most entitled to our confidence, 
especially in cicatrices of the neck, cheek, eyelids, nose, lip, is that in which 
" auto'plasty''' is brought into service. In all such operations, we are go- 
verned by the same principles, and pretty much the same mechanical details. 
They consist in, 

1. Dividing the cicatrix so as to produce a raw surface, in some part of 
its extent; or cutting it out entirely, as proposed by Hildanus. 

2. In applying to this raw surface a piece of healthy skin taken from the 
neighbouring parts. 

3. In attaching this skin by suture to the margins of the wound in which 
it is inserted. 

4. In approximating the edges of the wound, from which the skin has 
been removed. 

5. In separating, by appropriate agents the parts too closely approximated, 
and keeping them in this condition, some time after the flap has united. 

6. In applying oleaginous frictions, and motion to the new made parts to 
give them flexibility and softness. 

Many shocking deformities from burns have been relieved by the perform- 
ance of operations conducted on these principles; for example, the eyelid, 
the cheek, the nose, and the lip have all been restored: but I believe I may 
claim the merit (if merit there be in adapting an old principle to a new opera- 
tion), of having first performed an operation of the kind for the relief of 
extensive cicatrices of the throat. 

Mr. Liston, whose surgical acumen and boldness no one will deny, dis- 
tinctly states, in his last edition of the " Elements of Surgery," p. 263, 
*' that such defects are beyond the reach of surgery," and gives a drawing 
illustrative of the appearance of a person so afflicted — which drawing is 
almost a fac simile of my case No. 1. I have also carefully examined nearly 
all the modern works on the subject, and find no mention of such an opera- 
tion having ever been performed. Velpeau, in his " Medecine Operatoire," 



80 Peebles' Case of Gun-shot Wound of the Face. [J"ly 

article " Cicatrices Vicieuses," merely hints at the possibility of such an 
operation, but this is all. 

In very extensive cicatrices of the neck, it may be well to modify the 
operation so as to take 2. flap from each side, by which means we shall avoid 
the risk of a very large single flap. 

4. Cicatrices complicated with obliteration of cavities. — Where the cica- 
trix produces partial or complete obliteration of a natural opening, as the 
mouth, &;c. incision of the angles, and the introduction of tents larger 
than the natural opening, will occasionally do good; but for the most part 
all such attempts fail, and it becomes necessary to perform the operation of 
Dieffenbach, an account of which I published in the 18th No. of the Ameri- 
can Journal of Medical Sciences, for 1836. 

5. Cicatrices complicated ivith loss of organs. — Where organs are en- 
tirely destroyed, nothing short of a " plastic operation," the aim of which 
will be the construction of an organ as much like the original as possible, 
offers the slightest prospect of benefit to the patient. 



Art. VT. — Case of Gun-shot Wound of the Face, luith loss of a greater 
proportion of the Tongue, and extensive lesion of the bony structure, 
successfully treated; together ivith an account of interesting nervous 
Phenomena, resulting from the injury. — By J. F. Peebles, M.D., 
Petersburg, Va. 

In the month of August, 1840, Washington Perkins, a middle-aged man 
of robust constitution, but intemperate in his habits, induced by a fit of jea- 
lousy to attempt self-destruction, placed the muzzle of a fowling-piece, 
charged with duck-shot, immediately below and in front of the angle of his 
right jaw, and discharged the gun with his foot. 

I saw him a few minutes after the accident; the hemorrhage was frightful, 
though he was composed and sitting up in bed. Upon examination I found 
an entire breach in the inferior maxillary bone at the point where the shot 
had been received of more than an inch in length, involving the loss of the 
two lower molar teeth. Passing obliquely upwards through the mouth, 
the tongue was torn across in the line of the shot, all the free portion of it 
with the attaching fraenum, completely severed and thrown forward between 
the front teeth. The charge passed out through the antrum about three 
quarters of an inch below the eye, carrying with it also the two cuspidati 
and their alveolar processes. 

In addition to the injury of the inferior maxillary bone already named, 
there was a transverse fracture at the symphysis. Owing to the nature and 



1842.] Peebles' Case of Gun-shot Wound of the Face, 81 

peculiar situation of the injury, the means for arresting the profuse hemor- 
rhage were confined principally to rest in the recumbent posture and cold 
applications to the head, face and neck. But the quantity of blood which 
had found its way into the stomach, and still continued to trickle down the 
throat, despite our efforts to prevent it, very much embarrassed and impeded 
their effects by the frequent retchings it induced. As soon as fainting came 
on however, firm coagula formed in the cavity of the mouth and the orifices 
of the wounds, and the hemorrhage entirely ceased. In this stale he was 
left for the night with directions for the diligent continuance of rest and the 
cold applications to the head and face. 

During the night, from the frequent gratification of his intense thirst, the 
coagula were removed, and the bleeding partially returned, but a bit of ice 
in the mouth controlled it until the following morning, when all oozing was 
promptly suppressed by pledgets of lint soaked in a solution of kreasote ap- 
plied on the bleeding surface. 

His face and wounds now presented the following appearances. His 
mouth, particularly the lower portion of it, was drawn to the left side; he 
complained of feeling a notch in the glass from which he drank, owing to 
loss of sensation in the right portion of his lower lip, phenomena which in- 
dicated lesion in the motor and sensitive nerves which supply the lower 
portion of the face. Over the inferior maxillary bone where the charge had 
entered there was a circular but jagged wound of over an inch in circumfer- 
ence, either way, extending up on the neck. On introducing the finger the 
fractured ends of the inferior maxillary bone were found to present a remark- 
able peculiarity. Instead of being shattered, and split or splintered as might 
have been expected from the violence of the accident and the nature of their 
structure, the ends of the bone were found presenting regular and transverse 
surfaces, as if only that plug of bone had been clearly removed which had 
received the violent charge, without material injury to the adjoining portion. 
The osseous system of this man had always exhibited evidence of remark- 
able fragility. He had suffered fracture of the thighs five different times, 
and as it is usual in individuals suffering from fragilitas ossium, the bones 
had in each instance united, with but little inconvenience, and with remark- 
able facility. Was not the regularity and favourable nature of the fracture 
to be attributed to this condition of the osseous system, which, doubtless, 
was general? 

The end of the tongue was retracted and swollen, so as considerably to 
impede deglutition. The left antrum was exposed; whilst the external 
wound above presented the form of a triangular incision, with a flap perfectly 
preserved and thrown back. This was now brought down, the parts adjust- 
ing themselves perfectly together, and confined with adhesive plaster. 

The portion of inferior ^axillary bone between the symphysis and the 
breach at the angle had fallen inwards, protruding the teeth longitudinally 
into the mouth, and was so loose and detached as to occasion some thoughts 



82 Peebles' Case of Gun-shot Wound of the Face, [July 

of the propriety of its immediate removal. It was however erected into its 
proper position and confined as securely as the circumstances would permit, 
and for the few succeeding days the patient remained tolerably comfortable. 
After this time for the succeeding ten days alarming hemorrhage from time 
to time continued to recur, but by the diligent continuance of cold applica- 
tions to the head and face, together with the topical application of kreasote 
to the bleeding surface of the tongue and cheeks, it was checked; when he 
ceased to suffer further annoyance or danger from this score. At the end 
of the second week the external wound over the antrum had healed by the 
first intention, and although the antrum still remained exposed, the wound 
in the superior maxillary bone from this time gave no further inconvenience. 
The tongue was also well, and healthy granulations were shooting up in the 
wound in the right cheek. 'J'he detached piece of inferior maxillary bone 
became now the most embarrassing feature of the case. As it was not fast- 
ened at either end it was impossible, such was the state of the external 
wound, now to adopt any means by which it could steadily be held in its 
proper place a sufficient length of time for union to occur; and for up- 
wards of a month the prospect of its removal, either by necrosis or exci- 
sion, was improbable. About the middle of the second month, however, it 
had united at the symphysis, and at once the health of the patient, which 
had been kept feeble by the exhausting discharge and irritation about the 
mouth, rapidly improved. 

From this time the contraction of the muscles gradually approximated the 
ends of the inferior maxillary bones, and at the termination of the fourth or 
fifth month they became united, and the cure was complete. 

The following is the condition of the man's face at this time. Consider- 
ing the great loss of bone, its general contour is but little altered. The in- 
ferior maxillary bone, though somewhat shortened, and with the exception of 
a slight protrusion at the point where the union at the symphysis occurred, 
is perfect and suflnciently strong for the purposes of mastication. The 
remaining portion of the tongue, doubtless from the long inactivity of its 
muscles, is atrophied to a mere membrane. It has well developed papillae, 
however, and the taste still remains unimpaired. It affords no assistance in 
speech, or in mastication, (tlie finger being used in the latter operation to 
keep the material between the teeth,) but remains motionless on the floor of 
the mouth. The deglutition is perfect. The membrane covering the ex- 
posed antrum is healthy. The mouth is still partially drawn to the left side, 
and the muscles of the lower part of the right side of the face take no part 
in the expression of the countenance. During laughter they are motionless, 
grotesquely distorting the face. But as this state of things is confined to 
the lower part of the face, the eyelids and muscles on the side of the nose 
remaining unaffected, it is probable that the lesiori^is confined to the lowest 
branch of the portio dura on the face. A portion of the motor branch of 
the fifth pair is also complicated in the lesion, as the muscles of the right 
cheek are atrophied, and flap, from a want of consent between their action and 



1842.] ^wiioYiS Cases of Inversion of the Uterus. 83 

the motions of the jaw, in such a manner between the teeth as to prevent mas- 
tication on that side. But the sensation has returned in the lip. This occur- 
red soon after union had begun at the fracture near the symphysis, proving 
consequently, that the paralysis which had occasioned the loss of sensation 
was owing only to the pressure exerted by the displacement of bone, on the 
branch of the third division of the fifth pair of nerves, which emerges from 
the anterior mental foramen to be distributed on the lip. This man has re- 
turned to his old habits, and is frequently seen intoxicated about the streets, 
yet the bones of the face and the mucous membrane of the mouth continue 
perfectly healthy. Indeed the whole history of the case manifests a hardi- 
hood, and a strong disposition to the healthy reparation of injury in the 
osseous system which, I think, is quite remarkable. 
Petersburg, March 22, 1842. 



Art. VII. — Tioo Cases of Inversion of the Uterus. By W. L. Sutton, 
M.D., of Georgetown, Ky. 

Case I. — Nov. I6th, 1823. — I was desired to visit Mrs. S., who was 

said to be in labour. When I entered the room, the midwife observed there 

was something wrong. Upon making examination, the first thing which 

attracted my attention was a tumour, which from its size and firmness, I, for 

an instant, took to be the head of a child; and supposing the shoulders had 

engaged the pelvis unfavourably, I ran my finger up the neck to liberate 

them; when I found that this tumour was a part of the mother, and nothing 

less than the uterus inverted and expelled. I now first learned that the child 

had been born. The midwife assured me that she did not have a worse 

time than common; that the placenta came away in good time, and without 

difficulty; that the tumour followed it closely; and that not knowing what it 

was, she did not know whether to permit its exit or not. I endeavoured to 

replace it by grasping it between my hands, and after squeezing it for some 

time, pushing it in the direction of the outlet of the pelvis. But the tumour 

was so firm that little impression could be made upon it, and I was utterly 

unable to reduce it. Upon squeezing the uterus several blood-vessels 

spouted and bled for a short time. The patient had a ghastly aspect; lips 

bluish, pupils dilated, pulse very weak; yet the hemorrhage had not been 

considerable. She did not complain much; but I thought that was owing to 

her diminution of sensibility. Having become entirely satisfied that longer 

endeavours to replace the uterus would be fruitless, and must still hasten her 

dissolution, I desisted, and attempted to sustain her by stimuli small in 

quantity, and frequently repeated. In this also I failed. Her pulse soon 

disappeared, and she died in about three hours. This woman was said to 

be somewhat loose in her morals; had conceived three times, and miscarried 

once; at which time she was said to have had a prolapsus uteri. 



84 Sutton's Cases of Inversion of the Uterus. [J"ly 

Case II.— Oct. I9th, 1835.— Mrs. H. in labour with her first child— 
the uterus being expelled with the child. I saw her perhaps in half an hour. 
The placenta was yet partially attached to the fundus uteri; the body of the 
uterus completely expelled the vulva; no hemorrhage, great sinking, lips and 
countenance livid, pulse scarcely perceptible — the uterus not firm as in case 
1st. Sent off* for Dr. Richardson — separated the placenta and returned, by 
moderate and continued pressure, the uterus into the pelvis. Dr. Richardson 
arriving some time afterwards, completed the reduction. She continued very 
weak and faint, and had frequent retching. This state was considerably al- 
leviated by injections of starch and laudanum. In this case, the membranes 
gave way several hours before the child was born, the presentation natural, 
pains rather short and at considerable intervals. The body was not expelled 
by the same pain which expelled the head; but the uterus followed the body 
by the same pain; the cord was rather short. 

Evening. — She has taken small doses of stimuli during the day; also a 
dose of ol. ricini, which vomited her. Complains of great soreness, pulse 
weak and very quick, lochia proper; has passed no urine, nor felt any dis- 
position to do so. 

"Zath. — 3 o'clock, A. M. A great deal of pain in the uterine region — has 
passed no urine or feces, or feels any disposition to do so; pulse small, some- 
what hard and very frequent, severe headache. Drew off about three pints 
of urine: bled to^viii — cold water to head, ol. ricini ^ii. Evening. — Medicine 
operated well: dejections said to be proper, pulse still frequent (about 150,) 
headache undiminished, no abdominal pain, lochia have been rather profuse, 
but at present proper. Sinapisms which have been appHed to the head, hav- 
ing failed to give relief, a blister was applied to the back of the neck; lauda- 
num gtt. x. to restrain the operation of the oil; discharge of urine natural. 

21s/.— -Head still aches; pulse 132; bowels freely open; urine plenty; 
lochia proper; no milk. Blister drew well without materially relieving the 
head. 

226/.— 'Head still aches, skin pleasant; pulse 132; no milk; lochia offensive 
and pale. R* Draw the breasts, and wash the vulva and vagina with chamo- 
mile tea. 

23^.— Head somewhat relieved; skin pleasant; pulse 132; some appetite; 
no milk; urine scant; lochia offensive; bowels have not been moved for 36 
hours: a little tenderness in the uterine region. B. Injection of chamomile 
tea into the uterus and vagina: Seidlitz powders to keep the bowels regular. 

25/A. — The head has nearly ceased to ache, but feels very sore. The 
injections into the uterus appear to have benefited her much. No fetor 
attends the lochia: feels comfortable; skin natural; bowels in good order; no 
milk, but some soreness of the breasts. From this time she continued to 
improve, but her health remained delicate for some time. She never had 
any secretion of milk. In the management of this case I had the benefit of 
Dr. Richardson's advice, who saw her twice with me after the reduction was 
effected. 



1842.] Jb.xVis's Case of Extravasation of Blood, 85 



Art. VIII. — Case of Extravasation of Blood into the cellular texture, 
beneath the shin of the Penis. — By Edwarb Jarvis, M.D., Louisville, 
Kentucky. 

Jan. \4:th, 1841. — A thin healthy man, of the age of 27, while in coitu, 
and just before the orgasm, felt something give way in the penis. Never- 
theless, the orgasm followed, and the seminal fluid was ejected, but without 
the usual excitement. The organ was at once relaxed, but swollen and dis- 
coloured. He walked about half a mile, feeling a slight pain, and an 
increasing heaviness and fulness in the penis. 

I saw the patient in half an hour after the accident, and found the 
penis very much distended with venous blood, along the dorsum and the 
left side and around the prepuce. The diameter of the organ was greater 
than in the state of erection. On the right side, from one inch below the 
corona glandis to near the pubes, there was neither swelling nor discolora- 
tion; and here was a curve occasioned by the great distension of the oppo- 
site side. The swelling encircled the whole body of the penis at its root, 
and at the prepuce; and at the latter place the distension of the integument 
was greater than in any other part. There was neither pain nor tender- 
ness, nor difficulty in micturition. 

Three years previous to this accident, the patient had worn a very tight 
pair of pantaloons, the middle seam of which pressed so closely upon the 
left side of the penis, where it curved to lie upon the opposite thigh, as to 
cause much pain and tenderness at that spot, and especially at the time of 
erection. These symptoms, and a' local weakness never left him. It was 
precisely at this spot, that the rupture of the sheath of the corpus caverno- 
sum, appeared to be — and on this point alone, was any tenderness felt upon 
pressure. 

The extravasion was still going on, and the purple swelling increasing. I 
therefore directed absolute rest upon the back; application of lead-water to 
the swelling, without covering of bed-clothes over the hips and pubes. 

In one hour found the swelling somewhat greater, but the rapidity of its 
increase checked. Not wishing to open the skin while the hemorrhage was 
active, I ordered a solution of mur. amnion, in spirits and water equal parts, 
perfect rest, and cold for the night. 

15^/i. — Hemorrhage arrested; coagulation taking place; opened the skin 
with a bistoury, making a free incision longitudinally along the dorsum, and 
transversely through the prepuce on the right side. The blood oozed out, 
but the cellular substance was filled with coagula; directed the continued 
application of towels dipped in hot water, and the whole to be kept covered 
with blankets, to retain the heat, and promote the discharge of blood. 

At night, the blood had oozed freely from the incisions, and the swelling 
No. VH.—JuLY, 1842. 8 



86 Jarvis's Case of Extravasation of Blood. [July 

was diminished along the dorsum, and on the right side of the prepuce. 
Made another incision on the left of the prepuce; continued hot applications 
for the night. 

\Qth. — Swelling diminished; though not so much on the left side of the 
dorsum or elsewhere; made an incision on this side; continued applications 
of warm water. 

\lth. — Blood ceased to flow through the incisions, and these were healing. 
Supposing the rest of the coagula might be absorbed, I changed the hot to 
cold applications, and ordered the solution of ammonia, first covering the 
wounds with simple cerate, to defend them from the irritation of the am- 
monia. Gave also, submur. hyd. gr. vj, aloes gr. iv; comp. ext. colocynth 
gr. iii, M., which produced a small operation. 

\^th. — Absorption going on; swelhng diminishing. Bowels costive; gave 
sulph. magnes. ^i; continued cold lotions. 

\9th. — Swelling about the dorsum penis changing from the purple to yel- 
lowish hue; continued lotions. Gave him jalap pulv. gr. x, supertart. 
potass, gr. xii, M. Noon, no operation; much nausea; gave sulph. magnes. 
ji. Evening; vomited in afternoon; very feeble; absorption rapid. 

20/A. — Had four operations in night; with great nausea, yellowness of 
skin extending. Continued lotions. 

2\st. — One operation; swelling diminishing; organ nearer the natural 
shape and size. Corpus cavernosum feels somewhat distended, and hard. 

Patient has been, for many years, troubled with night erections, which 
have latterly increased. He had these, on the night both of the 20th and 21st. 
Then felt the pain, at the point where the sheath appeared to be ruptured. 
This erection was immediately relieved by the cold lotion. 

22c?. — Improving; swelling in cellular tissue diminished. . Skin more 
pale; corpus cavernosum hard as yesterday. Bowels costive; gave sulph. 
magnes. §i.; lotions as before. 

23(/.' — Salts operated favourably; patient feels well; swelling of skin 
mostly gone. The purple hue much diminished, and the sallow colour ex- 
tending. Corpus cavernosum somewhat hard and distended; penis not per- 
fectly relaxed, and flaccid as natural; no pain, but a little tenderness at the 
point of rupture. 

In all this time, there was no difficulty in micturition; no excitement, nor 
irritation nor heat in the body of the penis. Patient lay on his back until 
the 20th, confined himself strictly to vegetable diet, and cool drinks; where- 
by all inflammation was prevented. 

At 9 o'clock this morning, he started on a journey of two days, in the 
stage, over a hard road. 

February 2Qth. — He wrote for advice. " I arrived safely, without any 
pain or inconvenience. I have taken no medicine, nor made external appli- 
cations. I am better and improving, yet not well. The penis is reduced to 
its natural size, and all discoloration is gone; but the part where the rup- 



1842.] J^xv\s''s Case of Extravasation of Blood. 87 

ture was, is not quite healed: and on erection, the penis is bent, and drawn 
down to one side, and attended with considerable pain; I wish you to pre- 
scribe again for this condition of things." 

Advised frictions with ung. hyd., moderate diet, and exercise, and absence 
of all stimulants. 

*Bpril 5fh. — He again wrote, " I followed your prescription strictly as to 
the use of the mercurial ointment. I have, in a good measure, abstained 
from warm and strong food, and entirely from intoxicating drinks. The 
pain, during erection, has much abated, but the penis, when erected, is very 
much bent, and when not erect, there appears to be, in the body of it, at or 
near the place where the rupture occurred, a lump or hard substance, and al- 
though I have rubbed the part regularly, two or three times a day, I don't 
think it much diminished." 

Sth. — Advised cold douche and friction with iodine ointment, and the 
camphor liniment. 

May lOth. — Patient wrote, that under the influence of the cold douche 
applied daily, and the iodine ointment and camphor liniment, he was some- 
what better than when he wrote before. " But my improvement is very slow. 
The pain, during erection, is almost entirely gone; but there is still consi- 
derable chordee; my improvement was confined to the two first weeks of 
using the last prescription. Since that time I have been, I think, station- 
ary." 

Advised bandaging penis; keeping this wet with solutions of mur. am- 
monia, and occasional frictions with ung. mur. ammon. 

The patient improved through the summer; but the chordee, the local ten- 
derness, and slight swelling and hardness at the point of rupture, had not 
entirely disappeared in September, 1841, when he died of fever. 



88 



[July 



MEDICAL EDUCATION AND INSTITUTIONS. 



Art. IX. — On the condition of the Profession on the eastern coast of 
South £.merica, and the prevalent Diseases of that country. By H. 
Pleasants, M. D., of West Philadelphia. 

The following remarks, concerning the character and advantages of the 
medical profession on the eastern coast of South America, with observa- 
tions on the diseases of that country, are offered from a desire to lessen 
the difficulties which exist, of obtaining similar information through other 
sources, and a belief that they may prove useful to those junior members of 
the profession, who are in search of a locality suitable for the practice of 
medicine. 

The great field there ofTered for usefulness and fortune, appears highly 
favourable to those young men whose migratory disposition, unrestrained 
by love of home, or domestic ties, will facilitate their undergoing voluntary 
exile amongst an irreligious, ignorant, and immoral people. The informa- 
tion which I design to convey, has been derived from frequent conversa- 
tions with intelligent native and foreign gentlemen, within and without the 
profession; from personal observation during a residence in the country 
in the years 1836, '37, and '38; and from subsequent correspondence with 
friends residing in those regions. 

Disturbed as the country has been by civil and foreign wars almost con- 
tinually since its original settlement by Europeans, but little progress has 
been made in the sciences by any of the natives; with but few exceptions, 
their distinguished and professional men are foreigners, and of those few, 
by far the greater part were educated abroad. To France, Spain, and 
Portugal, the inhabitants are especially indebted for the few men of sci- 
ence to be found amongst them. 

In the whole empire of Brazil, containing an extent of country one-third 
greater than the United States, with a population over 4,000,000, includ- 
ing within its limits several large cities containing from 10,000 to 150,000 
inhabitants, there was, until the reign of Don Pedro I., the greatest deficit 
of the means of education. Previously to his reign, schools of any kind 
were rarely to be found out of the cities, and even a plain education in 
their native language (the Portuguese) afforded grounds for an enviable 
superiority. The salutary efforts commenced within sixteen years by 
that emperor, to improve the learning of Brazil, the leading statesmen who 
survive him have endeavoured to continue; and since his death many use- 
ful laws upon the subject of education have been enacted and are now in 
beneficial operation. A great amelioration is already visible in the cha- 
racter and information of the inhabitants, and foundations for still greater 
improvement are now laid, which promise to take from Brazil the oppro- 
brium of dependence upon imported learning. Aware of so great a de- 
ficiency of the means of an ordinary education, we are prepared to believe 



1842.] Pleasants on Medical Profession in Brazil, ^c. 89 

jthat the higher branches of science have been still more neglected; and 
since the efforts at amelioration could only affect them subseqiienlly to a 
reform in elementary education, that reform would show its salutary 
effects upon the sciences at a much later period. Such indeed has been 
the case, but it behoves me to confine my remarks to the department of 
medicine. 

Previously to the reign of Pedro I., so little attention was paid to teach- 
ing medicine and surgery, that a good medical education could not be ob- 
tained in the country, and the surgeons ranked with and performed the 
offices of their equally learned barbers. 

A hospital had been founded by a brotherhood of philanthropic Euro- 
peans, of the order Miserecordia, at Rio de Janeiro, as early as 1582, but 
it appears during a long period to have been conducted upon very unsci- 
entific principles. The emperor was the means of placing this institution 
on a proper footing for effecting charitable purposes, in the most advan- 
tageous manner, and of improving a military hospital which had been pre- 
viously located there. 

These institutions, both useful and flourishing, are conducted in a man- 
ner highly creditable to the country. Having had no opportunity of visit- 
ing the military hospital, I can say nothing of interest concerning it, but 
from personal observation I believe the Miserecordia (civil) hospital to be 
surpassed in usefulness, both to patients and pupils, by none of the simi- 
lar institutions in our own country. It is a large two story, airy building, 
erected in a well ventilated part of the city, calculated to hold from 200 
to 300 beds, supported by private charities and the income arising from 
legacies. The afflicted, whosoever he may be, is immediately admitted 
on application; sex is the only distinction; white or black, bond or free, 
have no preference shown them, but are to be found on contiguous beds, 
treated alike with kindness and commiseration. Three surgeons and 
two physicians have charge of the institution. Judicious clinical re- 
marks are regularly made to the students in attendance, and on a fatal ter- 
mination, every facility is afforded for an examination of the body, which 
no superstitious feeling prevents, even though conducted without privacy. 

One of the two physicians of this hospital, O. D. Mirebelles, an intelli- 
gent mulatto, was one of a number sent by Pedro I. to Europe, to receive 
his medical education. 

The different provinces are unable to make laws upon the subject of the 
profession, but physicians are responsible to those passed by the general 
government, at Rio de Janeiro. These are generally judicious, but in 
many places utterly disregarded. By law, any person practising without 
license, or writing a prescription in any other language than the Portu- 
guese, is subject to a considerable penalty; but my medical acquaintances 
and myself were nearly all unlicensed, and inattentive to the law relating 
to prescriptions. Yet no notice was at any time taken of our transgres- 
sions. 

Formerly there were appointed two examiners for the empire, one for 
surgery, and one for medicine, whose duty it was to examine all candi- 
dates wheresoever educated, and grant or refuse a license according to the 
ability of the applicant: but a system of favouritism having resulted, these 
offices were abolished, and there are now two institutions for medical in- 
struction, at either of which any foreigner who presents satisfactory evi- 
dence of having received a regular medical education, may obtain a license 

8* 



90 Medical Education and Institutions. [j^^^Y 

by paying a certain fee and passing creditably an examination by their re- 
spective i'aculties. 

One of these institutions is located at Bahia, in the northern part of the 
empire, of which I have heard but little favourable; the other is centrally 
situated at the Capitol Rio de Janeiro, possessing great advantages for ob- 
taining a sound medical education. Here are six professors engaged in 
teaching the ordinary branches, endowed with power to grant licenses to 
practise, but not to confer degrees. 

The requisitions to obtain a license are — a knowledge of the French 
language, attendance at the institution during five years, passing yearly 
examinations by each of the professors, and a thorough final examination 
by the whole faculty. A classical education is not essential. 

Such are now the advantages and facilities for obtaininsr a medical edu- 
cation in Brazil, but the short period of their existence, has not been suf- 
ficient to supply the great deficiency. 

We therefore find most of the interior, and many of the smaller cities, 
depending upon foreign countries for skilful practitioners, and some places 
are still relying upon the most ignorant pretenders. 

Some of these places I have visited, and of others I have received ac- 
counts to be relied on from intelligent persons. 

In addition to those places where the physicians are ignorant and un- 
skilful, many others present openings to foreigners, even when supplied 
by natives. For as might reasonably be expected amongst a people reared 
under the greatest superstition and moral degradation, we find mutual envy 
and distrust, corresponding with a consciousness of their own inferiority 
in moral virtues. On this account, therefore, there exists among afflicted 
natives, a prejudice in favour of foreign practitioners; and furthermore, the 
continued civil broils, from which scarcely any province in the empire is 
exempt, obliges the physicians and surgeons, accordingly as they have 
been ranked, to leave their residence, as this or that party is successful. 
But the discreet foreigner, protected by his own country's authority, re- 
mains unmolested to continue the practice of his profession. 

In connection with tiiese remarks, applicable to the country generally, 
a few words relative to the especial advantages possessed by certain of the 
cities on the coast, of which I have received more particular information, 
may not be deemed inappropriate. 

The city of Pernambuco, containing about 8000 inhabitants, having a 
considerable number of English, American, and other foreigners, had, in 
1837, no foreign physician, 

Rio de Janeiro contains 180,000 inhabitants, and though well supplied 
by intelligent natives, yet from the numerous English and American trad-, 
ers and residents, it offers considerable inducements to practitioners from 
their respective countries. The two stationed there, are already old, and 
liave realized fortunes. 

The beautiful island of St. Catherines, adjacent to the rich province of 
the same name, of which it is the principal seaport, though proverbially 
healthy, still sufi'ers from those epidemic and endemic diseases incident to 
the country, and from the deficiency of practitioners, also ofiers great 
advantages. 

Continuing our progress south, we find still greater prospects of success 
afforded in either of the three large towns in the province of Rio Grande. 
Though now greatly injured by the civil war which it has for the last five 



1842.] Pleasants on Medical Profession in Brazil, (^-c. 01 

years been continuing against the general government, this province is one 
of the richest in Brazil, and situated in a higher southern latitude, its cli- 
mate is less oppressive on account of heat than that of most of the other 
provinces. Porte Alegre, the capital, an important place, situated 200 
miles from the sea, in a romantic hilly district, is accessible to vessels 
drawing 8 to 10 feet water, and has considerable foreign trade, and about 
10,000 inhabitants. Here was no foreign practitioner, and the supply 
even of the natives was insufficient, 

Pelotas, situated nearer the sea, on an arm of the same water-course, 
accessible only to small vessels, is in time of peace a thriving, increasing 
place, containing about 6000 inhabitants, most of whom, with the neigh- 
bouring residents, are either direcdy or indirectly engaged in the import- 
ant and lucrative business of raising and slaughtering cattle for the export- 
ation of hides and beef. Here three physicians were established in large 
practice, one ignorant in the extreme and unpopular; another, a Scotch- 
man, nearly overcome by intemperance. 

The city of Rio Grande, though inferior to the above, is a seaport of 
considerable importance, situated near the sea on a barren sand heap. It 
contains generally 6000 inhabitants, and has three physicians well sup- 
ported; but during the war, the population was increased one-third, and 
six practitioners were generally employed. Here a small civil hospital is 
established for the relief of the afflicted poor. It is a well located, airy 
stone building, calculated for about 50 beds, and is under the care of one 
medical attendant, who receives a salary for his services, but is not denied 
the advantages of private practice. Being familiar with the treatment there 
pursued, I will briefly detail some few of the many cases of malpractice 
constantly occurring. Thus offering, by exposure of the errors in this 
hospital, a fortiori evidence of the great ignorance of the ordinary coun- 
try practitioners. 

Case I. The subject of this case was treated out of the hospital, by the 
surgeon subsequently appointed over that institution. An English gentle- 
man, aetat. 30, of good constitution, received a gunshot wound above the 
elbow, l^acturing the humerus, without much laceration of the soft parts; 
no attempt was made immediately to take up the bleeding vessels, or to 
treat the injury in a manner likely to save the limb, but a tourniquet 
applied tightly around it, entirely stopping the circulation, was permitted 
thus to remain 24 hours. Mortification of the parts below, apparently the 
result of this ill-judged treatment, soon followed, for which subsequent 
amputation at the shoulder joint was deemed advisable, and wonderful to 
say, successfully performed. 

Case II. An American sailor suffering under syphilis, was discharged 
from this institution, after long continued medication, as incurable; he was, 
however, restored to health, in a few weeks, by the judicious treatment 
recommended by an American gentleman, out of the profession. 

Case III. A mulatto sailor, from Baltimore, aetat. about 35, with good 
general health, was admitted into the same institution, suffering under 
recent popliteal aneurism succeeding a blow upon the part. He was 
treated for several weeks with different discutient applications, without 
any beneficial result, and finally was subjected to amputation of the thigh, 



92 Medical Education and Institutions, [J"b' 

notwithstanding my remonstrances to the contrary, and recommendation 
of the unheard-of operation of tying the femoral artery. Amputation was 
performed in the most unskilful and barbarous manner it is possible to con- 
ceive. " Sugar-loaf stump" followed, apparently the result of the length 
of bone; and at my final visit to the hospital, nearly three months after the 
operation, the surface of the stump was still unhealed, and the patient 
reduced to the last stage of hectic fever. 

The medical practice pursued in this institution is no less deserving of 
censure; but though replete with convincing proofs of extreme and fatal 
ignorance, the limits assigned to this article will forbid the details of indi- 
vidual cases. 

The facilities afforded by either of the above mentioned locations for an 
extensive practice being spoken of, it becomes proper to refer to the pecu- 
niary advantages to be anticipated. The fees for professional services are 
not estabHshed by law, but are generally regulated by the reputed wealth 
of the individual, and where the demand for payment is made soon after 
recovery, whilst there is felt that sense of gratitude too soon extinguished, 
a reliance upon the generosity of the individual is not unfrequently most 
advantageous. Thus are the largest fees often received: 100, 200, or 300 
dollars are by no means uncommon remunerations after a short attendance 
during severe illness. 

Where an important operation is about to be performed for a rich per- 
son, it is customary to arrange previously the compensation, and thus fees 
of from $300 to $500 dollars, are occasionally paid immediately for those 
performed for calculus, cataract, hernia, and other surgical diseases. 

Practitioners in the cities are frequently called upon to visit persons re- 
siding in the adjacent country, and for such visits, to rich individuals, the 
fees paid at the time are always full, often large, and occasionally exceed- 
ingly liberal. 

Physicians are never accustomed, as in the United States, to wait a 
definite, I had almost said an indefinite period, for the amount of their 
bills, but payment is either ofTered or solicited shortly after the requisitions 
for their services have ceased. 

In prosecuting the last division of my subject, it is not designed to pre- 
sent a full account of the diseases incident to the country, but merely to 
designate in a brief manner those which the newly located practitioner will 
most commonly be called on to encounter; thus affording him, by even a 
very superficial account of the number and character of the adversaries 
with which he will be obliged to contend, information which may enable 
him to make suitable preparation for the contest. 

Drawn chiefly from observations of diseases occurring in the southern 
and colder part of Brazil, my remarks will be principally, though not ex- 
clusively, applicable to the diseases of that region. 

The heat of the climate prepares us to expect a great prevalence of cu- 
taneous diseases, but these are principally to be found amongst the lower 
classes and slaves — the higher orders suffering scarcely more than the 
inhabitants of the United States; an exemption probably attributable to 
their great attention to personal cleanliness, by frequent use of general 
and topical baths. 

Lepra is occasionally found, and elephantiasis, particularly of the scrotum, 
is one of the most common diseases in the warmer parts of the country. 



1842.] Pleasants on Prevalent Diseases of Brazil, ^c. 93 

The scrotum is at times so enlarged by it, as almost to preclude the loco- 
motion of the unfortunate individual afflicted. 

Measles, scarlet fever, and smallpox, are of very frequent occurrence; 
and I frequently was told of epidemics of the most malignant and fatal 
character of scarlet fever, but no opportunity was afforded me of seeing 
either this disease or measles. A violent and very fatal epidemic of 
variola occurring during my residence in Rio Grande, brought many cases 
of this disease under my notice. They presented no peculiarities distin- 
guishing them from the disease as it occurs in this country in the unpro- 
tected — but the rapid extension, and frightful ravages made in that com- 
munity not guarded by vaccination, afforded the most satisfactory evidence 
of the salutary effects of that prophylactic. Cases presenting the pecu- 
liarities of varioloid, as known amongst us, I never saw during that epi- 
demic. 

The Brazilians have never been made fully aware of the advantages of 
vaccination. In 1811 two vaccine institutions were established at Rio de 
Janeiro, but the operations there performed having failed to protect from 
smallpox, a doubt of its possessing such power gradually increased; and 
though frequent attempts at introducing this virus have since been made, 
but little confidence is felt in the protection thus obtained. Inoculation 
with the virus of variola is practised to a considerable extent, and so far 
as my experience (by no means inconsiderable) may be relied on, the 
danger of the disease thus produced is but small, when modified by diet 
during the period of incubation, though it fails no less than the natural 
smallpox to prevent the system from a second attack. 

The dangerous contagion thus produced leads us, however, to hope that 
the blessings of vaccination will yet be duly appreciated in Brazil. 

During this epidemic, fresh vaccine virus was imported, with which I 
made several trials. The patients, all children, presented the peculiar 
diagnostic characteristics of the cowpox sore, and being afterwards sub- 
jected to the contagion of smallpox, all without exception escaped. 

Diseases of the thoracic viscera are less frequent by far than in the 
United States, but are to be found possessing the character of all the 
varieties here occurring. 

Though the Brazilians cannot justly be considered an intemperate 
nation, the higher classes indulge too freely in stimulating drinks and the 
pleasures of the table; we therefore find, as might be anticipated, diseases 
of the digestive organs by no means rare. Dyspepsia in all its grades is 
frequently encountered, and functional and organic diseases of the liver, 
with their consequences, are of the most frequent occurrence. Apoplectic 
and paralytic affections are also common. 

Sporadic cases of diarrhoea and dysentery are observed at all seasons; 
and during the summer, epidemics of them attacking all classes and ages 
are frequent. It is somewhat remarkable, however, that cholera morbus 
so nearly allied to the above, is comparatively a rare disease, and in a vio- 
lent form possessing the characters of Asiatic cholera, almost unknown. 
That scourge of infants in the United States, cholera infantum, I never 
saw during my residence in the country. 

Typhoid and simple inflammatory fevers present no peculiarities, either 
in the frequency of their occurrence or symptoms, distinguishing them from 
the same diseases occurring in the United States; but those febrile affec- 
tions of intermitting and remitting types, arising from marsh miasmata, it 



94 Medical Education and Institutions, [July 

is said, are never to be found in Brazil. An American physician, practising 
in an adjoining province, remarked, after several years experience, that he 
had never seen a case of ague in the country, excepting in foreigners who 
had arrived from miasmatic districts in the United States. 

Tetanus, comparatively seldom seen in this climate, is in Brazil a very 
common disease. After changes in the atmosphere from hot and dry to 
cold and wet, it is not unusual for a practitioner to be called, within a few 
days, to several cases of idiopathic tetanus; and during such periods all 
kinds of wounds are likely to be followed by the disease; even the simple 
operation of phlebotomy is at limes performed with fear, on account of 
such result occasionally following. The tendency to this disease is found 
to extend even to the inferior animals; castration frequently produces it, 
and the simple excision of part of the tails of sheep, frequently performed 
to prevent a noxious disease to which they are subject, is at times followed 
by the most disastrous consequences, by producing tetanus. 

As we might naturally be led to anticipate, from the known immoral 
character of the inhabitants, diseases of the urinary and genital organs are 
of great frequency. Calculus, strictures, enlarged prostate, and their 
consequences are common: and the treatment of syphilis and gonorrhoea, 
in all their forms and varieties, composes no small item in the ordinary 
labours of the surgical practitioner. These diseases occurring in the 
natives, present no special marks of interest. But syphilis contracted by 
a foreigner, it has been remarked, and I believe with truth, is peculiarly 
severe, attacking the different organs of the body, and ru-nning its course 
with extreme rapidity, and frequently proving fatal. 

Attributable to whatsoever cause, the extreme frequency of loxarthrus is 
particularly striking. The most frequent varieties are to be found occur- 
ring in the knee-joints of negroes, which are at times so deformed, that the 
leg, when extended, forms with a line continuing the direction of the thigh, 
an angle of 60 to 70 degrees, being occasionally directed outwards or in- 
wards, confined to one or equally affecting both lower limbs. Club-foot is 
10 be found in all its varieties, occurring about as frequently as amongst 
our own inhabitants. 

Hernia is very frequently to be found, more so than in this country, and 
at times is to be seen of an immense size; but strangulation of the pro- 
truded part is much more rare than amongst us, and when occurring de- 
mands less frequently an operation for its relief. 

The practice of midwifery is so generally confined to uneducated w^o- 
men, that a physician may pass years in extensive practice without being 
called to a single case of labour amongst the native females: indeed, his 
aid is never sought, save in unnatural cases, and from what I could learn 
through others, the fact appeared undeniable, that native Brazilians suf- 
fered much less during the act of parturition than the females in this 
country; however, the great frequency of uterine complaints occurring 
amongst married women, leads to the opinion, that much advantage would 
result from greater dependence upon scientific practitioners in this depart- 
ment of the profession. 



1842.] 95 



REVIEWS. 



Art. X. — Traite des Nevralgies, ou affections doidoureiises des nerfs. 

Par F. L. I. Valleix, Medecin du Bureau Central des Hopitaux, &c. 

Paris, 1841, 1 vol. 8vo. pp. 719. 
^ Treatise on Neuralgia. By F. L. I. Valleix, Physician to the 

^^Bureau CentraV of the Hospitals, &c. Paris, 1841, pp. 719, 8vo. 

This work is dedicated by its author to M. Louis, and is one of the 
most recent monuments erected by the school of which that distinguished 
physician was the founder. By the system of study pursued by the mem- 
bers of that school, M. Valleix has done for neuralgia what M. Louis did 
for typhoid fever and phthisis, and other authors, in a like way, for other 
diseases. He has taught us what neuralgia is, as distinguished from affec- 
tions which previous authors have confounded with it; he has discovered a 
physical test by which its existence and extent can be certainly ascertained, 
and the best treatment correctly applied; and finally, he has, by the aid 
of numbers, reached general conclusions in regard to it, which are not 
likely to be set aside, so long as the phenomena of disease, as well as of 
health, shall be governed by uniform and fixed laws. 

M. Valleix, while he regrets the meagerness of the descriptions given 
by most of his predecessors, has studiously examined all the contribu- 
tions to the history of neuralgia, contained in ancient, modern, and 
contemporary literature; and wherever he has found a general portrai- 
ture of the disease, or particular cases of it, given in any detail, he has 
added them to the materials collected by himself for his treatise. With 
such means at his disposal, he has considered each variety of neuralgia 
by itself, including the anatomy of the affected nerves, the literary history 
of the disease, its varities, the mode of detecting it, its symptoms, both 
general and local, its course, duration, and termination; its lesions; its 
predisposing and exciting causes; its diagnosis and prognosis; its remedial 
and prophylactic treatment. The work concludes with an essay on neu- 
ralgia in general, in which the characters common to the several varieties 
are brought together, forming a complete and accurate summary of all that 
is known about the disease. 

In giving an account of the work, we shall begin with this last divi- 
sion of it, in order to avoid the necessity of following the author in his 
very minute descriptions, repeated as they are for each variety in succes- 
sion, and also to give the reader a general idea of the manner in which the 
subject is examined. 

M. Valleix gives the following definition of neuralgia as that to which 
his observations have led him. " A pain of variable intensity disseminated 
in certain circumscribed points along the course of a nerve; these points 
being proper centres, whence emanate, at variable intervals, lancinating or 
other analogous pains, and upon which pressure is more or less painful 



96 Reviews. \_^^^Y 

when it is appropriately employed." (P. 2.) All those pains of the internal 
organs which have been described and treated as nervous, are of course 
excluded from this definition, and intentionally; for, while some of them 
are clearly dependent upon previous functional disorder in the organ where 
they exist, and occupy a large surface of that organ, others are due to the 
presence of organic disease, cancer, for instance, which presses upon, or 
otherwise excites pain in a healthy nerve; while, in neuralgia proper, the 
pain in the nerve is the starting point of the disease, and its characteristic 
symptom; the altered functions of the organ it supplies with filaments are 
only accessory phenomena. There may be affinities between the subcu- 
taneous neuralgiae and the painful affections of internal organs; but in a 
practical work the author has done well to disregard these doubtful analo- 
gies, and confine his researches to " an affection of the principal nervous 
trunks which ramify near the surface of the body, and whose symptoms 
are so distinct as to warrant their arrangement in a separate pathological 
group." 

Only two of the varieties of neuralgia seem to have been known to the 
ancients, the sciatic, and the trifacial. The former of these was described 
by Hippocrates, and the latter was noticed by Aretojus; but for a metho- 
dical history of the first of these affections we are indebted to Cotunnius 
(1764), and of the other to Andre (1756). Chaussier, in 1804, originated 
the term neuralgia, and guided by his anatomical knowledge, formed as 
many varieties of the disease as there were single nerves, or nervous 
plexuses, affected by it. This classification gave clearness to the subject, 
and was the origin of many treatises, some of which have notably favoured 
the advancement of medical science. 

The principal writers upon neuralgia agree that the superficial nerves 
are chiefly, if not exclusively, the seat of the disease, but they fail to 
notice what particular points in these nerves are most painful. M. Val- 
leix has shown that the severest, and often the only pain in a nerve 
exists where this latter becomes superficial lohether by emergirigfrom a 
bony or muscular enclosure, or by the distribution of its terminating 
branches to the integuments. Illustrations of this proposition will be given 
when we come to speak of the several forms of neuralgia. 

The prominent symptom of neuralgia is pain; every other is only secon- 
dary to this; hence in a general description of the disease, we have to 
attend to the seat, and the character, including the degree, and the varia- 
tions, of the pain. First, then, as regards its seat. When a patient suffering 
under an attack of neuralgia is asked where he feels the pain, he will 
either complain of it in the whole, or in certain points of the course of 
a nerve, generally using the former description during the paroxysms of 
lancinating pain, and the latter in the intervals between them. It is dur- 
ing the paroxysms, that the pain is felt over the most extensive surface, 
not only in the trunk, but in one or more of the superficial branches of the 
nerve primitively affected, and in those of the neighbouring nerve with 
which they anastomose; in this way the disease may be propagated by 
contiguity, and by the more intimate connections of nervous filaments, until 
it invades almost the whole body. Some nerves, however, seem to 
have the disease strictly confined to themselves, during its whole course; 
such are the inferior maxillary, ulnar, and ilio-scrotal nerves, perhaps be- 
cause their branches anastomose but sparingly with otiier nerves derived 
from the same sources. The usual restriction of the disease to a sing-le 



1842.] Valleix on Neuralgia, 97 

nerve, or set of nerves, has given rise to its division into trifacial, bra- 
chial, and other varieties, to be presently considered in detail. 

The character of the pain is twofold: it may be either dull, and con- 
stant, like that of a bruise, or may be sharp, lancinating, intermittent, or 
irregular; and either of these pains may be spontaneous, or excited either 
by the movements of the patient, or by external pressure. The dull pain, 
although not the most violent, is very annoying, (a fact observed by Co- 
tunnius, but neglected by many subsequent writers,) and is absent in 
very few cases. 

The lancinating pains have been found by M. Valleix to emanate uni- 
formly from one or more of the points occupied by the pain just described, 
or by that which pressure occasions. These are centres whence the pain 
radiates with greater or less acuteness, and which are always painful them- 
selves, while the nervous trunks between them are only momentarily 
affected. Sometimes, indeed, a pain will pass from one to another of 
these centres, without causing any sensation in the intermediate nerve, and 
this latter may remain quiescent between points which are at the same 
instant the seat of intense suffering. The darting pain may also fol- 
low a direction opposite to that of the nerve. This peculiarity was 
observed in 6 out of 109 cases, while in 62 of them the pain was in the 
course of the nerve; in 16 it was fixed and disseminated; in 11 felt some- 
times in one point, and sometimes in another; in 5 it started from the same 
spot to shoot upwards and downwards; in 6 followed no regular direction; 
and was absent in 3 cases. 

M. Valleix found that when a nerve is affected with neuralgia, a greater 
or less number of its superficial points are morbidly sensible to pres- 
sure. But the majority of medical writers, so far from admitting that 
pressure upon a neuralgic nerve gives rise to pain in it, insist that it has a 
soothing influence in most cases. Some indeed say that slight pressure 
augments, while firm dissipates the pain; others think that pressure is not 
painful at all, and others, again, admit it to be so, but very rarely. But 
M. Valleix shows that the existence of this symptom was recorded in 
thirty-nine out of a hundred and thirty-four cases observed by the very 
authors who have asserted its absence, and in most of the ninety-five other 
cases, there is nothing to prove that the symptom was made a subject 
of inquiry at all. This is not a solitary example of men putting forth 
general propositions which the particular facts collected by themselves 
flatly contradict. It is much easier to write one's general recollections, 
than to make a strict analysis of what has been really observed. 

M. Valleix examined every case of neuralgia that came under his notice, 
with a view to determine this question, and, with a single exception, he 
found the affected nerve painful upon pressure, in one or more points; the 
exception was a slight case of sciatica observed by him only within thirty- 
six hours of its onset; the symptom was then absent, but may have existed 
subsequently. The pain upon pressure sometimes consists merely in a 
temporary aggravation of the constant dull pain, and sometimes in shoot- 
ing ones like those which occur spontaneously. The slightest weight 
upon a tender point is sometimes enough to bring on frightful paroxysms^ 
or cause the patient to shriek with anguish. 

The extent of the painful surface is readily ascertained by pressure, and 
has frequently been found not to exceed a quarter of an inch in diameter, 
its limits being so abruptly defined, that at the distance of a single line 
No. VII.— July, 1842. 9 



98 Reviews, [July 

from a point where pressure produced pain, no evidence of morbid sensi- 
bility could be elicited. It cannot be doubted that here is one of the rea- 
sons why the descriptions of previous authors have been imperfect. It is 
easy to conceive that painful points of so small extent might escape the 
notice of a superficial observer, and that pressure with the open hand might 
fail to produce any effect upon them, because bearing principally upon the 
surrounding indolent parts. When writers have affirmed the existence of 
spots painful under pressure, they must have fallen by chance upon a ten- 
der point, or have met with those exceptional cases where the sensitive 
surface is unusually large. In order, then, to determine the state of a 
neuralgic nerve, the whole of its trunk and principal ramifications must be 
carefully pressed with the end of the finger, both in the parts complained 
of by the patient, and in those where there is no spontaneous pain. For 
pressure may, in the latter case, excite pain, and indicate the extent of the 
affection. 

It should, however, be borne in mind that, occasionally, when pain has 
been caused by pressure on a given point, a few moments afterwards 
the same experiment may not have a similar result, although a short pe- 
riod of repose will again restore to the point its original sensibility. There 
are, too, some parts of the body, such as the anterior wall of the chest, and 
the scrobiculus cordis, which are naturally painful under moderately firm 
pressure in thin persons of a nervous temperament. If pain, therefore, is 
found in such points, it should not be attributed to neuralgia, without 
making pressure upon a corresponding part of the opposite side of the 
body. If it is absent there, the pain first observed may be referred to a 
simple neuralgia. In cases of double neuralgia, one side is usually more 
painful than the other; there is, moreover, between the opposite tender 
points, a considerable indolent space, while a continuous soreness is found 
there in cases of general morbid sensibihty, presented by the individuals 
just referred to. 

The pain excited by pressure is generally in direct proportion to the 
violence of the disease, is greatest during the paroxysms, and least in the 
intervals between them; it is almost uniformly to be found in the points 
where pain exists spontaneously. Thus, in 111 out of 112 cases, the 
excited and spontaneous pains coincided in the same points; the latter ex- 
isted without the former in one case only. But this coincidence did not 
happen strictly in every affected point of each patient; in some parts, one sort 
of pain only was manifest, but in other parts of the same individual, the two 
were always found conjoined. It will be perceived how important is this 
physical exploration to the discovery of the seat of the disease; its value 
will appear still greater when we come to the subject of treatment. 

We pass over the paragraphs relating to the functional changes in 
organs supplied by nerves affected with neuralgia, and to secondary 
symptoms and complications, merely noticing the author's statement, that 
in females suffering under this disease the menstrual function is very fre- 
quently disordered. Thus in 24 out of 65 patients, it was regular and 
without pain; in the others there was irregular, painful, or deficient 
menstruation. Before drawing any conclusion from these premises, we 
should have to ascertain what proportion of otherwise healthy women, in 
a large city like Paris, enjoy an exemption from all the disorders to which 
the catamenia are liable. We suspect that the number would be found 
much smaller than is commonly supposed. 



1842.] Valleix on Neuralgia, 99 

Neuralgia is eminently a paroxysmal disease. Out of 155 cases, one 
only was without this character. But there is a striking difference be- 
tween paroxysms occurring at irregular intervals, and those whose periodi- 
city at once suggests the idea of a latent intermittent fever. The instances 
of the latter sort are infrequent; they were noted in about one-tenth of the 
cases of neuralgia of all kinds. But regular intermissions were most com- 
mon in the trifacial variety, that is, in nearly one-fourth of the cases, while 
they were observed only in about one-seventeenth of the cases of the other 
varieties. It is worthy of remark, that although sulphate of quinine was 
administered in all the cases where periodicity seemed to indicate its use, 
yet about half of them only appeared to yield to the remedy, and the rest 
were quite unaffected by it. 

It has often been said that the onset of neuralgia is sudden. This is 
true of the individual paroxyms for the most part, but not of the disease 
itself. Its accession is more commonly gradual, not only as to the inten- 
sity of the pain, but also as regards the number of the points attacked. 
These are few at first, but go on increasing in number. When the disease 
is at its height, it is subject to frequent variations, which many physicians 
have attributed to atmospheric changes. M. Valleix, however, has found 
only a low temperature, and that independent of moisture or dryness, evi- 
dently coinciding with the severest attacks or paroxysms of neuralgia. 

The duration of neuralgia is uncertain. Its termination is never fatal; 
a radical cure was effected in about three-fourths of the cases observed 
and collected by M. Valleix; (139 out of 182.) Many of these cases were 
probably taken from the works of physicians who had published them as 
proofs of the success of some favourite treatment, and the result to which 
they lead ought to be received with caution, especially when we consider 
that the cure obtained is rather of the particular attack, than of the disease 
itself, since in persons once subject to it, there is a strong predisposition 
to its recurrence upon the slightest inattention to prophylactic measures. 

Like most other diseases, neuralgia is much more curable in its earlier 
stages than subsequently. Yet a cure must not be despaired of, even 
when the disease appears inveterate, for it has been effected, says M. Val- 
leix, in cases of six, thirteen, and fourteen years standing. 

As to the anatomical lesions of neuralgia, all our knowledge concerning 
them must be expressed in a single sentence. The changes found in 
nerves which had been the seat of this disease are far from beins^ peculiar 
to it; and, on the other hand, it is certain that neuralgia may exist during 
a long term of years, without leaving behind it any appreciable lesion. 

The causes of neuralgia are involved in great obscurity. In a large 
majority of cases, no cause can be assigned for an attack of the disease, 
but in a certam number of his cases, M. Valleix thinks that the prolonged 
action of severe cold was the immediate source of the malady. In regard 
to the predisposmg causes, M. V. has shown that of 297 cases, more than 
two-thirds of them occurred in persons between twenty and fifty years 
old; a proposition equally applicable to a great variety of diseases. It 
follows also, from the analysis of our author, that the two sexes are equally 
liable to the disease, but that of its varieties, the sciatic and crural neural- 
gias are most common in males, and the dorso-intercostal and lumbar, 
in females. These results are, however, only given as provisional; a 
much larger number of cases than have yet been collected are necessary 
for the true solution of the problem relative to this point, as well as to the 



100 Reviews. [July 

constitution, temperament, and condition of the patient, his mode of life, 
food, &LC. The influence of the seasons is hardly doubtful: of 125 cases, 
77 commenced during the five months beginning with December, and 48 
during the other seven months, so that the proportion during the cold 
weather was about double of that furnished by the warm seasons. 

Diagnosis. — Neuralgia is very liable to be confounded with neuritis. 
The distinctive characters of the two have been laid down by M. Martinet 
and other authors. According to them the pain of neuritis is more fixed, 
and may be recognized by the shortness and imperfection of its remissions, 
by its gradual rather than its sudden return, and by its aggravation under 
pressure. M. Valleix is not convinced that these symptoms, and espe- 
cially the last one, are characteristic of neuritis, but does not take upon 
himself to decide the question without further observation. When a 
nerve is pricked, torn, or bruised, or compressed by a tumour, it may be 
the seat of lancinating pains like those of true neuralgia. Is there any- 
thing besides the evidence furnished by the history of such a case to dis- 
tinguish it from neuralgia? This too is a subject which requires the 
examination of observant physicians. Muscular rheumatism is a very 
analogous disease to the one under discussion. It consists merely, in pain, 
which has a superficial seat, and is often marked by exacerbations, but it 
may be known by its occupying a more extensive surface than neuralgia 
does; by its increase during contraction of the aflected muscles, for the 
pain so excited is always much more intense than the spontaneous one; 
and lastly, by its vagueness in rheumatism, while it accurately follows the 
course of the nerve in neuralgia. 

The article on general treatment will find a more appropriate place after 
our analysis of the chapters which describe minutely the several varieties 
of neuralgia; and to them we now proceed. 

Trifacial Neuralgia. — We omit the excellent description given by the 
author of the distribution of the fifth pair of nerves, and pass at once to 
his general remarks upon the disease. Fifty-five cases form the basis of 
his essay, and of these only twelve were observed by himself in all their 
details. The rest, which are borrowed from various native and foreign 
authors, are silent in regard to many important points. 

M. Valleix thinks that trifacial neuralgia ranks next in frequency after 
the dorso-intercostal and lumbar varieties. As regards its causes, the re- 
marks already made upon neuralgia in general will apply to this form of it. 
It frequently happens, however, in persons of a nervous temperament, and 
in those who have suffered from diseases of the nervous system. There 
is no evidence of its ever following upon syphilis. Caries of the teeth has 
given rise to it, although no instance of this has occurred to M. Valleix. It 
is equally liable to attack either side of the face, but is rarely double. 
When a single branch of the nerve is aflfected, it is usually the inferior 
dental. The two varieties of pain above described are met with, the dull 
and the lancinating, and these at the points of emergence, or anastomosis 
of the nerves, as shown in the following abstract. 

A. Painful points in the course of the ophthalmic branch, — 1st. At 
the supra-orbital foramen. — Eleven times out of thirteen the patients 
ferred to this spot as the seat of their pain, although in two cases it ex- 
tended for a certain distance along the nerve. 2d. Two patients com- 
plained of a pain in the eyelid and the edge of the orbit, which probably 
resided in the nasal branch of the ophthalmic. 3d. Three had a painful 



1842.] Valleix on Neuralgia. 101 

point just within and below the internal canthus of the eye. This point 
is mentioned by various authors sixteen times, but is not accurately 
defined by them. 4th. Several patients complained of pain in the eyeball 
itself; in one it was confined to that organ; similar cases are described by 
authors. M. Valleix was not able in any instance to discover pain in the 
tiunk of the nerve, while in its bony canal, but only when it became 
superficial. 

B. Painful points in the course of the superior maxillary branch. — 1st. 
At the infra-orbitary foramen. — A dull pain existed there in the three out 
of fourteen patients seen by M,. Valleix, and is noticed only six times in the 
cases of various authors, from which it is inferred that this is not a frequent 
seat of the disease. 2d. Over ihe malar bone. 3d. The teeth and gums 
of one side were the seat of a vague and diffused pain in nine cases out 
of sixteen; in the remaining seven the pain was confined either to the 
upper or to the lower jaw. 4th. The upper lip. 5th. The palate was 
affected by neuralgic pain in four cases detailed by authors, in one of 
which the right side of the tongue, as well as of the palate, was so much 
involved as to prevent the articulation of words, during the paroxysm. 

C. Painful points in the course of the inferior maxillary branch. — 1st. 
The temple. — A sharp pain was felt in six cases at the lower part of the 
temporal region, just in front of the ear, and in every instance the surface 
affected did not exceed two-fifths of an inch in diameter. 2d. The tern- 
poro-maxillary articulation was painful in one case where the disease was 
limited to the inferior maxillary nerve. 3d. The mental foramen was the 
seat of pain in five cases observed by the author, and in two recorded by 
other writers. It should be remarked that where this point existed, the tem- 
poral was also found, making it probable that the latter was in the course of 
the branch of the fifth nerve supplying the region of the same name. 

Parts of the tongue and lower lip are also painful occasionally. 

D. Painful points where the branches of the trigeminus anastomose. 
— The most remarkable of these is the parietal, and is usually found 
a litde above the protuberance of that bone, and occupies a space not 
exceeding half an inch in diameter. M. Valleix observed it in one half of 
the cases analysed in his treatise, and has since had occasion to recognise 
it in five patients. It may indeed be said that this point is constant in all 
pretty severe neuralgias of the face, excepting, however, when the disease 
is limited to the inferior dental nerve. 

The question now occurs, what divisions of trifacial neuralgia should be 
admitted? The greater part of authors, with Chaussier at their head, have 
made as many divisions as there are nervous filaments interested. But if 
we regard the following resiilt it will be evident that such minuteness must 
be barren of all practical utility. 

Painful points in all three branches 24 times. 
" two " 11 " 

" " one branch 10 " 

From this table it appears that the cases in which one branch of the 
trigeminus was alone affected, were not numerous, even supposing the 
table to be rigorously correct. But, very probably, the authors from whom 
some of these numbers are borrowed noted the existence of the disease in 
one branch only because the pain was severest there, and certainly they 
did not use the test of pressure to determine the state of the other branches. 

9* 



102 Reviews. [July 

Hence we are led to view facial neuralgia as the same disease, in whatever 
branch of the fifth pair it may be seated. In regard to the point where 
the affection usually begins, M. Valleix can find no case of its originating 
in the superior maxillary nerve; but of 22 cases noted by himself and 
others, sixteen commenced in filaments of the first branch, whence it ex- 
tended to others, and six in the inferior dental nerve, where it remained 
fixed. 

The " points" which have been indicated must be looked upon as centres 
of pain, and characteristic of neuralgia. Pressure upon them nearly always 
caused suffering, and that within very narrow limits, so that on one side 
of a line there would be acute pain, and on the other none whatever. In 
many instances pressing very lightly brought on severe pain, but in none 
was a contrary effect produced by firm pressure, so far from it that the 
anguish was then intolerable. Pressure rarely developed pain in the in- 
tervals between the " points," these latter were always more sensitive 
than the other portions of the nerves, and in almost every case the seat of 
spontaneous suffering. A large majority of the patients experienced a 
remarkable exacerbation of their symptoms during mastication and deglu- 
tition, sometimes while blowing the nose, or moving the head or eye. 

Spontaneous lancinating pains occurred at variable intervals, sometimes 
following the course of the nerve, sometimes going contrary to it, and 
sometimes starting from distant points simultaneously. Various sensations 
also existed at the same time, such as of burning, gnawing, boring, or of 
simple tension; some patients compared their pain to an electric shock, a 
dragging, pinching, &;c. Occasionally the state of the parts supplied by 
the trigeminus was altered. Thus in a certain number of cases there was 
intolerance of light, redness of the eye, and an involuntary flow of tears; 
less frequently there was heat in the nose, and a mucous discharge from 
its lining membrane. Some patients complained of humming and whist- 
ling sounds in their ears, but none had toothache. These symptoms be- 
longed to the more serious cases, and so did contortions, convulsions, 
spasms, and tremulous movements of the face. Some authors have at- 
tributed these phenomena to nearly all cases of the disease which they 
eutide " tic douloureux," but it is plain that their descriptions do not 
include the milder and more numerous cases. The intermissions be- 
tween the paroxysms were commonly very irregular, and in instances of 
apparently well marked periodicity, " the failure of sulphate of quinine," 
says our author, " frequently proved that there was really no intermittent 
fever;" a conclusion we should be sorry to adopt on such evidence. It is 
not more rational to deny the existence of intermittent fever in cases 
where the preparations of cinchona are unable to cure the disease, than it 
would be to consider the syphilitic nature of an affection disproved because 
it had not yielded to mercury. Experience and science have done justice 
upon the latter opinion, once universal, and we should therefore be the 
more cautious how we admit a similar belief in regard to any medicine 
whose usual success in curing a particular disease may tempt us into call- 
ing it a specific. 

The exacerbations of pain in trifacial neuralgia took place equally by day 
and by night, and more usually under the influence of^ a notably diminish- 
ed temperature, than any other appreciable cause. Its duration, alleged 
anatomical lesions, and essential nature, require no notice here. 

The diagnosis between it and inflammatory afTections of the head is 



1842.] Valleix on Neuralgia. 103 

easy, especially when the aid of pressure upon the nerves is resorted to. 
M. Valleix thinks that nervous headache (migraine) is often neuralgic, and 
claims hystericus always so. To this latter opinion we can add the sup- 
port of one case, where, during the painful hysteric paroxysm, and for 
some time after, there was great tenderness on pressure over the parietal 
protuberance, the mastoid process, and the point designated by M. V. 
as " temporal," just in front of the ear: and of another where pressure 
gave pain at the lower part of the temple, and at a point about halfway 
between the mastoid process and the spine. In both these cases there 
was puffiness of one side of the scalp during the paroxysm; in both there 
was also more or less delirium; the one patient had previously been sub- 
ject to hysterical convulsions; the other was anemic, and just conva- 
lescent from an attack of dorso-intercostal neuralgia when the disease 
attacked her head. 

M. Valleix examines with great minuteness, and in a very interesting 
manner, the question: " Is the facial nerve ever the seat of neuralgia?" 
We can only give an abstract of his principal conclusions. "When his 
patients were interrogated they uniformly declared that the pain darted 
from behind the ear upon the face, and had he taken their word for it with- 
out inquiring further, he might have been led into error like most 
others. But, by means of closer questions and the use of pressure, it 
turned out, 1st, that it was not either immediately from under or behind the 
ear that the pain darted, but from behind the mastoid process, and at some 
variable point between it and the vertebral column; 2(1, that the shooting 
pains passed over the occipital bone at a greater or less distance from the 
ear, to be felt above the parietal protuberance; .3d, that at this spot there 
was a sensitive point whence pain could radiate over the different parts 
of the face by means of the branches of the temporal and frontal nerves. 
From the whole discussion it is to be inferred, 

1st, That there is nothing in the anatomical distribution of the nerves of 
the face to prove that in a given case the pain resides in the facial rather 
than in the fifth nerve, since their terminating branches anastomose at all 
points where pain has been said to exist in the former. 

2d. The most conclusive physiological experiments have shown the 
facial nerve to be naturally insensible. 

3d. The recorded cases of so-called neuralgia of the portio dura are 
wanting in the most important details. 

4th. In cases siri^ilar to those on record, the point of departure of the 
pain has been found not in the facial, but in the occipital nerves. 

5th. If neuralgia should hereafter be found to exist in the facial nerve, 
the intimate anastomosis it forms with the trigeminus will sufhce to ex- 
plain its acquired sensibility. 

Cervico-Occipital Neuralgia. — The nervous branches concerned in 
this disease are, 1st, The superficial cervical, which passes under the skin at 
the posterior edge of the sterno-cleido-mastoid muscle, about the middle 
of the neck; 2d, the auricular; 3d, a branch of the anterior trunk of the 
second cervical nerve which ascends behind the mastoid process towards 
the parietal bone; 4th, the supra-clavicular, and acromial; and, most 
important of all, the occipital, which is a continuation of the posterior 
trunk of the first cervical nerve, and accompanies the occipital artery, after 
traversing the trapezius muscle; its branches supply the scalp, and many 
of them anastomose with those of the frontal nerve above the parietal pro- 



104 Hevieios» [July 

taberance. The following are the points where pressure excites pain: 1st, 
one, and the most sensitive, between the mastoid apophysis and the first 
cervical vertebra, a little nearer the latter than the former; 2d, at the 
emergence of the superficial cervical nerve; 3d, near the parietal protu- 
berance; 4th, upon the mastoid process; 5th, upon the concha. 

This form resembles trifacial neuralgia in the character of its pain, but 
is of much rarer occurrence. The direction and' extent of the pain has 
already been noticed in connection with the subject of facial neuralgia, so 
that we may pass to the next variety. 

Cervico Brachial Neuralgia, may occupy one or several of the 
branches of the last four cervical and first dorsal nerves, either before or 
after their intertexture in forming the axillary plexus. The most import- 
ant points are the following: 1st, where the posterior branches emerge from 
the muscles at the sides of the lower cervical vertebrae; 2d, where the 
plexus in the axilla is superficial; 3d, where the supra-scapular and cir- 
cumflex branches are found, the former upon the spine of the scapula, the 
other around the surgical neck of the humerus, and between the integu- 
ments and the deltoid; 4th, where the internal cutaneous nerve, superfi- 
cial along the inner side of the arm, is distributed partly to the internal 
condyle, and partly to the anterior face of the wrist, after furnishing a fila- 
ment placed behind the median basilic vein, and which, when wounded in 
venesection, has been- the seat of intense suffering; 5th, where the median 
nerve passes through the pronator teres, and where it gives off the palmar 
cutaneous branch and supplies the sides of the fingers; 6th, where the 
ulnar nerve lies behind the internal condyle, where it passes superfi- 
cially between the pisiform and unciform bones to reach the hand, where 
it sends off filaments to the last three fingers; 7th, where the musculo- 
spiral passes round the humerus, and gives off cutaneous branches at its 
entrance into, and its exit from, the humeral groove. 

Any of these points may be the seat of spontaneous pain, or of that pro- 
duced by pressure, but both sorts are most frequently found in the axilla, 
in front of the elbow and the wrist, and behind the internal condyle. The 
last situation is the most common of all the painful localities, and the affec- 
tion of the ulnar nerve by far the most frequent. 

Dorso-intercostal Neuralgia. — The study of this variety was ne- 
glected until 1818, when the memoir of Nicod was published. This author 
mentions his having met with two hundred cases of the disease, and gives 
a general description of it, in which he asserts that it occurs much oftener 
upon the left, than upon the right side, in the proportion, namely, of 15:1. 
M. Valleix passes rapidly in review the essays of French, English, and 
American writers who seem to have had this subject in view, and amongst 
the latter the papers of Dr. J. Parrish and Dr. Porter published in this 
Journal. The want of precision in describing symptoms, and the per- 
petual mingling with them of hypothetical notions make these works of 
small value. The vague, or rather meaningless term, " spinal irritation," 
and the quackery of one or two books concerning it, which nevertheless 
emanated from sources of some consideration, were both adapted to turn 
scientific inquirers aside from a subject which had been wrested from its 
native domain by the unhallowed hands of nostrum-mongers. The first 
researches into the symptoms of this disease, which are entitled to be 
called scientific, are those of M. Bassereau in his inaugural thesis, and those 
of M. Valleix, both published about the beginning of 1840, in the " ./^r- 



1842.] YaWe'ix on Neuralgia. 105 

chives Generates,'''' &c. We shall give as concise a notice of the results 
obtained by these gentlemen as the great interest of the subject will allow. 

And first, in regard to the anatomical characters of the spinal nerves. 
It should be borne in mind that these nerves arise from the spinal cord at 
points above those of their exit through the intervertebral foramina. After 
its exit each nerve divides immediately into two branches, the posterior of 
which traverses the muscles at the side of the spine, and is distributed to 
the skin of the back, while the anterior runs forwards between the inter- 
costal muscles, at the middle line of the side sends a filament to the integ- 
uments, and then at a point near the sternum, or the outer edge of the 
upper portion of the external oblique, penetrates the intercostal muscles, 
and is distributed to the skin of the anterior part of the thorax, and the 
superior of the abdomen. So that we have three superficial branches; 
1st, over the intervertebral foramen; 2d, at the middle of the intercostal 
space; .3d, near the edge of the sternum, or of the rectus. 

Some of these points were found to be painful in every case, either with 
pressure or without it, in a space not exceeding half an inch, and the ten- 
derness was occasionally such that the slightest touch, or raising of the 
skin, gave rise to the acutest pain. When the pain occurred spontaneously, 
it generally commenced at the posterior point, and darted through all, or a 
part, of the course of the nerve, though its point of departure was some- 
times either lateral or anterior. 

Taking together the observations of both the gentlemen just mentioned, 
it appears that of 62 cases, the disease was double in 20, on the right side in 
13, and on the left in 29. The number of intercostal spaces affected varied 
from one to eight, and was noticed in those from the fourth to the ninth, 
inclusive, much oftener than in the others. In no case was there any ap- 
preciable connection between the nervous disease, and that of any of the 
thoracic or abdominal organs. 

M. Bassereau, however, is of opinion that the uterus and its appen- 
dages are often to be regarded as the primitive or starting point of this variety 
of neuralgia, and this he founds upon the frequent coincidence of uterine 
affections with it. On the other hand it is objected, that of females affect- 
ed with the other forms of neuralgia, more than half were subject to ute- 
rine disturbance whose connection with the nervous complaint, whether 
as cause or effect, there was no reason to suspect; and that those men- 
tioned by M. Bassereau, and who had tenderness of the neck of the womb 
and alteration of its functions, were really sufTering under lumbo-abdominal 
neuralgia, which was the cause, and not the consequence, of the derange- 
ment of the uterus. Besides all this, the etiology in question would of 
course be inapplicable to males, of whom there were eleven out of fifty-six 
patients. 

From the short account, even of the disease, here given, it is plain that 
it cannot easily be confounded with affections of the lungs and pleurae. 
Even at the onset of these latter the presence of fever and cough, and the 
absence of the circumscribed painful points, will prevent mistakes. It is 
less easy to distinguish intercostal neuralgia from muscular rheumatism, 
but the characters of both have already been noticed. Some writers have 
thought angina pectoris a form of neuralgia, but M. Valleix does not 
think this doctrine admissible in the present state of medical science, 
chiefly for the reason that in all the cases of intercostal neuralgia he has 
seen none of the symptoms of the first named disease. The question, 



106 Reviews, [July 

however, is open. Certain diseases of the spinal marrow occasion pains 
more or less confined to its neighbourhood. In spinal meningitis the pain 
is more acute and diffused, and is heightened by pressure upon the spi- 
nous processes: there are frequently convulsions, permanent muscular con- 
tractions, or tetanus. The patients affected with softening of the spinal 
€ord, have a pain, which, starting from a fixed point of the spine, sur- 
rounds the abdomen, or the base of the chest, giving a sensation like that 
of a tight belt. Pressure upon the spinous processes over the diseased 
part causes pain, but none is caused by the same means applied a little to 
one side or the other, nor is there any lateral, nor anterior " point." In 
caries of the vertebrae, as is well known, pain may be excited in the dis- 
eased bone by pressing laterally on the ribs with which it articulates; but 
in neuralgia the pain is developed, not by pressing upon a rib, but in an 
intercostal space, not at a distance from, but at the point where the finger 
bears. 

LuMBO-ABDOMiNAL Neuralgia.- — We shall not dwell long upon this 
variety, which is rare, and chiefly interesting from its identity with the 
affection described by Sir Astley Cooper as irritable testis. The painful 
points are the following; 1st, the lumbar, where the posterior nervous 
branches reach the skin; 2d, the iliac, about the middle of the crest of the 
ilium; 3d, the hypogastric, just above the external abdominal ring; 4th, 
the inguinal, about the middle of Poupart's ligament; 5th, the scrotal or 
labial, at the lower end of the testicle, or in the labium majus of the 
female. Several of these points were painful in the ease of a young man 
who attributed his sufl^erings to a venereal excess. He began by feeling 
in the left testicle a pain which was at first slight, but afterwards increased, 
it darted from the testicle to the groin, and sometimes to the crest of the 
ilium and the loins. These four points were all morbidly sensitive, the 
testicle most of all, and chiefly at the lower part of the epididymis. There 
was nothing remarkable about the size of this organ, nor in the colour and 
thickness of the skin of the scrotum. 

Crural Neuralgia is rarely met with alone, but most frequently com- 
plicated with sciatica. It is seated in the anterior crural nerve, or its 
branches. At its origin this nerve is intimately connected with the sciatic 
plexus; it is superficial at the groin, about the middle of the sartorius, over 
the internal condyle, around the malleolus internus, and at the inner side 
of the sole of the foot. In all these points pain has been felt, either when 
spontaneous, or developed by pressure. 

Femoro-popliteal Neuralgia. (Sciatica.)— Since the time of Cotun- 
nius, very little addition has been made to our knowledge of the pathology 
of sciatica. The disease has been studied chiefly with a view of perfect- 
ing its treatment. M. Valleix thinks, however, that there was room for 
improvement in both of these points, and he has endeavoured to do his 
part towards it. The materials for his essay upon this variety of neural- 
gia consist of 125 cases in all, of which 89 are collected from various 
authors, 15 observed by himself, and 21 by M. Louis. These last, our 
author observes, although recorded in 1813-14, are much more carefully 
drawn up, and furnish more exact details, than most of those recently 
published. 

M. V. considers the afl^ection not only as it shows itself in the sciatic 
nerve, properly so called, but also in the branches of the sacral plexus of 
which itself is the terminating branch. The most important of these, for 



1842.] YaXle'ix on Neuralgia. 107 

our present purpose, are those which, outside of the sciatic notch, form 
the gluteal plexus, and send superficial filaments upwards to the attach- 
ment of the gluteus maximus to the crest of the ilium, and a cutaneous 
branch, which, after forming loops near the tuberosity of the ischium, 
sends down the back of the thigh branches which extend to either condyle, 
and are covered only by the crural aponeurosis. The sciatic nerve lies 
deeply under the muscles until it approaches the ham. Here it gives off; 
1st, the peroneal nerve, which is superficial in the ham and around the 
neck of the fibula, and which supplies the external malleolus, and the back 
of the foot; 2d, the communicating tibial, which is superficial at the mid- 
dle and lower part of the calf, and lies along the outer side of the tendo- 
achillis, and the external malleolus; 3d, the lower part of the posterior 
tibial nerve lying along the inner side of the great tendon, and behind the 
internal malleolus. 

In one or more of the following points there was a constant pain, which 
was always aggravated by pressure. 1st. In the region of the hip, in 
thirty-six cases, pain was found at the posterior superior spine of the 
ilium, 35 times; at the middle of tiie crest, 8 times; at the upper part of 
the sciatic notch, 16 times; at the great trochanter, 26 times. 2d. On the 
thigh. In thirty cases the pain occupied the whole length of the thigh, 
though it was most acute about the tuberosity of the ischium, at the middle 
of the member, and a little within the insertion of the biceps. These 
three points were the only seats of pain in a few cases, and to them the 
patients, of their own accord, referred their suff'ering. 3d. The knee was 
painful in its whole extent in 17 cases, but especially so at the outer part 
of the ham, and at the head of the fibula: these points were alone affected 
in 9 cases. 4th. Jn the leg. The whole length of the fibula was painful 
in 9 cases, in three of which there were points of remarkably acute pain 
just above the malleolus, and at the middle of the bone. 28 patients com- 
plained of pain along the posterior edge of the fibula; at the septum of the 
two bellies of the gastrocnemius, in 15 cases, and a little exterior to the 
spine of the tibia in five cases, there was pain. 5th. The foot, including 
the malleoli, was afi'ected in 25 cases, and over its whole surface in 8 
cases, in 7 of these, however, the greatest uneasiness was felt behind the 
external malleolus. The toes, the internal malleolus, and the sole of the 
foot were occasionally painful; the posterior tibial which supplies these 
regions is not so superficial as the peroneal nerve, a fact which is suffi- 
cient to explain the comparative exemption of the former from neuralgia. 

Sciatica is the most common form of neuralgia after the dorso-intercostal 
variety. It is rare in childhood, and is oftener seen in men than in women. 
It sometimes accompanies affections of the spinal marrow. Our author 
has never observed it as a metastastic disease, nor as a consequence of 
venereal infection; he thinks it sometimes depends upon disorders of the 
menses, and that its immediate cause, when discoverable, is oftener severe 
cold than any thing else. The lancinating pains so generally thought 
essential to this disease, existed in all the cases indeed, but not at all stages 
of them. In the beginning, the pain was usually dull, and exasperated by 
every movement; in the middle part of the course of the disease, the lan- 
cinations were observed in every one of M. V.'s cases, but they disap- 
peared during its decline. In 16 out of 36 cases the lancinations followed 
the course of the nerve, in 5 they ascended or descended, and in 11 were 



108 Reviews. [July 

fixed and disseminated. M. Louis noted the absence of this symptom in 
3 out of 21 cases. 

Besides this sensation many patients suffered from others of a different 
description. Generally, there was a feeling of cold in the usual seat of 
the pain, but no appreciable difference in the temperature of the two sides 
of the body. It most frequently occurred in the winter season, and on 
retiring to bed. In three cases there was a sensation of intense heat in 
the part; in one an intolerable itching, and in numerous instances local 
shiverings. 

In a few cases there were cramps either upon coming out of a bath, get- 
ting into bed, or during the violence of the paroxysms. Convulsions 
occurred in one case only, and that of very long standing. M. Valleix 
has not often met with atrophji^ of the affected limb, as described by pre- 
vious authors, and he is inclined to ascribe it, when found, to the long 
inaction imposed by the intensity of the pain. Sciatica is very rarely of 
a strictly intermittent character. This, like other forms of neuralgia, is 
readily confounded with muscular rheumatism. It may also be mistaken 
for coxalgia in its early stages. But in the latter disease, although the 
patient complains of pain in the knee, there is not, upon pressure, any 
morbid sensibility in it; the period of life also is to be taken into account; 
the constitution of the patient, the exact seat of the pain in the hip, that 
on moving the limb, the accompanying symptoms of fever, &c. Sciatica 
has sometimes been confounded with paraplegia, and with neuritis: after 
what has been said, it is needless to insist further upon distinctions which 
every cautious observer will perceive. 

Treatment of Neuralgia. — M. Valleix believes the usefulness o^ nar- 
cotics to be entirely limited to their paUiative influence during the parox- 
ysms. Physicians who have thought they had a curative effect, perhaps 
did not consider that the slighter attacks of the disease often get well with- 
out any medical interference. The suhcarhonate of iron was not given 
alone in many of the cases which our author has analysed; he cannot, 
therefore, express a positive opinion concerning it. From what we know 
of the properties of the preparations of iron, it would seem probable that 
their influence upon neuralgia must be indirect, and greatest in cases where 
there is also anemia. Very few of M. V.'s patients appear to have had 
any disease but neuralgia; other physicians more frequently find it com- 
plicated; and this may, perhaps, explain why our author speaks so dispa- 
ragingly of internal treatment in general. Sulphate of quinine was tried 
in 18 cases where there appeared every indication for its use; the result 
was 6 cured, and 2 relieved. The pills of Meglin (composed of equal 
parts of extract of henbane, powdered valerian, and oxide of zinc,) have 
been most frequently used in trifacial neuralgia, and they are thought to 
have been useful in some cases, but were occasionally given by their 
inventor in doses which a prudent physician would certainly hesitate to 
prescribe. The oil of turpentine has been greatly extolled for its cures of 
neuralgia, and especially of sciatica. The fullest account of its use is to 
be found in the work of Martinet, of whose cases, M. Valleix has made 
a minute analysis relatively to the point in question. His conclusion is, 
that this remedy has been too highly praised by some, and too much de- 
preciated by others; that among the cases of Martinet there are some where 
a cure was effected, in from six to ten days and sometimes less, of persons 
who had suffered for months under sciatica, for which other treatment had 



1842.] YaWeix on Neuralgia. lOD 

been vainly tried; and that all the negative facts in the world cannot deprive 
these positive ones of their full value. The administration of oil of tur- 
pentine, however, requires caution. 

The actual cautery, the section of the nerve, electricity, and several 
other modes of treatment are examined at length in the work before us. 
The first two are set aside, the one on account of its cruelty, and the other 
for its ordinary inefficacy in addition. The third agent is not considered 
by our author as worthy of the confidence which has been placed in it by 
M. Magendie. 

Blisters have been used in the treatment of neuralgia by a great many 
physicians, since the time of Cotunnius. One of the latest .writers on 
the disease, (Dr. Bennett, in the " Library of Practical Medicine,") says, 
*' Blisters have been occasionally applied, but the opinion of Dr. Heberden, 
that they are calculated to aggravate superficial neuralgia, is supported by 
recent experience, and their employment is now almost confined to the 
treatment of sciatica." The result of our author's " recent experience" is 
rather different. He says — 

*' It is evident that if something more remains to be done for the treatment of 
this affection, the facts which I have brought together are sufficient to prove the 
efficacy of certain means, and chiefly blisters, especially flying blisters applied 
upon the painful points. New observations prove to me every day that this is 
the treatment ;jar excellence, when there is no special indication opposed to it." 

In another place he mentions that blisters formed the basis of treatment 
in fifty-two cases: thirty-nine of them were cured, seven relieved, and six 
unaffected by them. These last mentioned cases were not treated as perse- 
veringly as they should have been. 

The account given by M. Valleix, of this medication, when speaking of 
the treatment of sciatica, is so interesting that we offer no apology for 
presenting an abstract from it. 

" The blisters were dressed with epispastic ointment, which occasioned a 
keen smarting, and often an increase of the pains. In the cases, too, v/hich got 
well, it was not till several days after the dressings were applied, and when the 
denuded surface was less tender, that the improvement commenced.* ***The 
reflections sugg^ested by these facts led me to continue the use of blisters, by 
increasing their number without keeping up their discharge, and by applying 
them over all the points where pain existed, or could be developed by pressure. 
I employed this method with all the patients I had to treat, of whatever form 
their neuralgia.****Will this means always succeed? That may not yet be 
affirmed. But it should not be forgotten that in all therapeutic questions rela- 
tive to diseases of active and marked symptoms, it is not only important to in- 
quire whether or not the treatment cured the disease, but v*^hether it acted in a 
rapid and direct manner upon the principal symptoms, and it is by keeping in 
mind this latter influence, that I have been struck with the beneficial effects of 
numerous flying blisters in neuralgia. 

" Cotunnius, as is well known, was a great admirer of the treatment by blisters; 
he proposed, by employing this exutory, to evacuate the morbific humour he 
imagined to exist within the sheath of the nerve. He sought the most favour- 
able point for fulfilling this indication, and [for sciatica] thought he had found 
it over the head of the fibula. But he did not confine his blister to this spot, 
he extended it across the popliteal space, and the tibia, exactly over the parts 
where the existence of spontaneous or excited pain, now indicates the applica- 
tion of the same remedy. Moreover, he did not use any stimulating dressings 
to keep his blisters open. The success he obtained was such that he feared to 
be accused of boasting, if he proclaimed it. Yet Cotunnius had not adopted 
No. Vn.— July, 1842. 10 



110 Reviews. ^ • [July 

the above named points for the application of blisters, to the exclusion of all 
others. He was often obliged to place them upon other portions of the nerve, 
and, by a happy coincidence, his theory led him to select those which are the 
most constant seats of pain, viz. the external malleolus, the instep, the head of 
the fibula, and the outer edge of the ham. We, who cannot admit a theory 
having no foundation in facts, may yet profit by the results of experience. We 
should be guided in our selection of the points for applying blisters, by the 
statements of the patient and by an accurate search for painful spots, according 
to the principles already laid down, and, in case an exceptional point should be 
discovered, ought to treat it like an ordinary one. The number of blisters to be 
applied at the same time must be settled by the practitioner, according to the 
intensity of the disease, and the number of the painful points. In severe cases 
I have applied three at a time, each of them about an inch in diameter." 

We have attempted to make such an analysis of the treatise of M. Valleix 
as should present his own discoveries distinct from the historical and 
critical portions of the work. But in doing this, we have, in order to 
avoid prolonging this article unduly, been obliged to give very litde more 
than an abstract of the author's own abstracts. Besides incidentally con- 
tributing to the settlement of a great many questions relative to the 
symptomatology of the disease, M. Valleix has established two very 
important propositions, viz. 1st, That neuralgia exists in the most super- 
ficial portions only of the spinal nervous system, where it can be detected 
by pressure upon the affected nerves; and 2d, That the most certain, and 
the speediest cure for it is flying blisters applied over the various painful 
points in the course of the nerves. It should be recollected that these are 
not opinions, that they are not hasty inferences from imperfectly registered 
or only remembered cases; but that they are logical inductions from cases 
minutely and honesdy studied, and recorded when observed. They have 
a value entirely irrespective of the talents or the reputation of M. Valleix, 
although it required the patience and yet the earnestness of a lover of 
truth, to develop them from out of the vast mass of materials that had 
been collected. 

We are not disposed to criticise a work which is so fruitful in good. 
We hope that some one may be found willing to undertake its translation 
into English, both for the sake of the valuable information it contains, 
and for its excellence as a model for future observers. We have yet much 
to learn about the functional diseases of the nervous system, and the plan 
of study pursued by our author may perhaps be found still farther appli- 
cable to them. A. S. 



Art. XI. — The Climate of the United States and its Endemic In- 
fluences. Based chiefly on the Records of the Medical Department' and 
Adjutant GeneraVs Office, United States Army. — By Samuel Forry, 
M.D. New York, 1842: 8vo. pp. 378. 

The merit of being the first to establish, on an extensive scale, the re- 
cording and collecting of meteorological observations, with the view of im- 
proving our knowledge of the climate of the United States, is we believe 
due to the late Surgeon General of the United States Army, Dr. liOvell, 
who about twenty years ago issued instructions to the surgeons at the different 
posts to keep regular records of the weather, and transmit them to the de- 



1842.] Forry on the Climate of the United States, 111 

partraent at Washington; and in 1826 he published the results of these 
observations for the preceding four years. 

The first state that adopted measures to obtain meteorological obser 
vations from its various sections, was New York, where the academies 
and other schools established under legislative patronage have been bound, 
for many years past, to keep meteorological registers, and make reports 
of the results to the Regents. The legislature of Pennsylvania, in 1836, 
made a liberal appropriation for similar purposes, by means of which 
each county in the state, fifty-four in number, is supplied with a set 
of meteorological instruments, with which observations have been made 
and reported monthly to a special committee of the Franklin Institute 
at Philadelphia, where they can be consulted at all times by persons en- 
gaged in meteorological investigations. Ohio has within the last year 
come into a similar measure, so that we have now a very extensive dis- 
trict of country embraced within the borders of New York, Pennsylvania 
and Ohio, covered, as it were, with points of instrumental meteorological 
observation. When to these efforts of individual states we add those of the 
Medical Bureau of our army, embracing observations not only at posts with- 
in the older settlements, but also at those in the most remote parts of our 
territories; and also those made under the direction of the British authori- 
ties in their extensive possessions, it may be said that in future little want 
can be experienced of meteorological data, by which the progress of 
storms, and all the great atmospheric movements can be traced through 
the North American Continent. To those engaged in solving the intrica- 
cies of meteorological phenomena, the importance of such means of in- 
formation need not be dwelt upon. 

It is therefore with particular pleasure that we hail the treatise before 
us, a pleasure which we are sure will be reciprocated at large by our medi- 
cal brethren, who cannot fail to appreciate the value of such a collection 
of authentic matter in relation to the climatology of our country, from the 
oldest settlements on the Atlantic coasts, to the farthest out-posts of civi- 
lized occupation, even to the shores of the Pacific. The volume is very 
appropriately dedicated to Dr. Lawson, Surgeon General of the United 
States Army, under whose direction the investigation of the subject was 
first undertaken by tlie author in the " Army Meteorological Register," 
and the " Statistical Report of the sickness and mortality of the army of 
the United States," both of which publications we have already had occa- 
sion to notice favourably in this Journal. 

The authentic materials employed in the composition of the volume be- 
fore us have required years to collect, and years to collate and digest. — 
All this labour has been accomplished through the design and execution, 
by members of the medical profession. Dr. Forry's work may therefore 
be regarded as a new contribution to science by that faculty which fur- 
nishes by far the largest proportion of labourers in the field of philosophi- 
cal research. 

Dr. Forry divides his work into two general divisions or parts. 'J'he 

Jirst division is devoted to the elucidation of the laws of climate in general, 

and especially to the climatology of the United States, 'i'he second 

division treats of the endemic influences peculiar to the systems of climate 

developed in the first part. 

In accordance with the motto derived from Malte Brun, that " the best 
observations upon climate often lose half their value for the want of an 



112 Reviews. [Wy 

exact description of the surface of the country," our author gives a bold 
outline of the physical features of the United States and territories, stretch- 
ing from the Atlantic to the Pacific Oceans, and from the Gulf of Mexico 
to the Northern inland seas. 

1. The Atlantic Plain, is viewed as shghtly elevated above the sea, gra- 
dually widening from a {ew miles in the North, to upwards of 150 miles 
in the South. This alluvial zone, sloping gently to the ocean, has in 
many places extensive marshes, swamps, sluggish streams, and innume- 
rable inlets from the sea. The deposits swept by the mighty rivers 
into the tide-water region, afford but too many sources of noxious efflu- 
via, or miasmata. 

2. The Apalachian range of mountains terminating this plain, has a 
mean altitude above the sea of about 2500 feet, with crests rising occa- 
sionally to the height of 3000 feet. Its spurs separate from each other so 
as to form extensive valleys of great beauty and fertility, having an ave- 
rage elevation of 1000 or 1200 feet above the ocean. The western de- 
clivity of this Apalachian or Alleghany range, descends into the great Mis- 
sissippi plain or basin, extends through the centre of the continent from 
the Gulf of Mexico to the Arctic Sea, and stretches westward to the Rocky 
Mountains or Great Chippewayen range. This vast valley is computed to 
contain not less than 3,250,000 square miles, and is undoubtedly the 
largest continuous body of lands of the highest natural fertility to be found 
on the globe. It already counts its millions of inhabitants, and is destined 
in the order of nature to rival, even perhaps excel, in population the teeming 
plains of India and China. The grand mountain chain into which the 
Mississippi valley rises on the west, called by the various appellations of 
Rocky, Chippewayen, and Oregon, is a prolongation of the Andes, or 
Mexican Cordilleras. Rising from a common base of about 3000 feet 
above the level of the sea, the average height of the summits above the 
base is set down at 5000 feet, some of the crests being not less than 8,000 
or 10,000 feet above the adjacent country. 

Beyond this bold chain and still farther west, we find the range of the 
Pacific coast, properly called, stretching northward from the peninsula of 
California. They are from 80 to 100 miles distant from the ocean, and 
have peaks rising even above the most elevated of the Rocky Mountains, 
some, we are informed being 10,000, 15,000, and even 18,000 feet above 
the level of the sea. The summits of these as well as those of the Rocky 
range, must necessarily be above the line of perpetual congelation. Thus 
is the territory of the United States geographically divided by two great 
systems of mountains into three natural subdivisions, namely, the Atlantic 
table-land and plain, the Mississippi valley, and the Pacific region. 

To this view of the geographical systems into which the United States 
and territories are naturally divided by mountain ranges of sufficient eleva- 
tion to produce modifications of climate, a description of the general cha- 
racter of the surface at the present day, may be appropriately added, in 
the words of our author. 

" From the shores of the Atlantic to the Mississippi, there is presented an im- 
mense natural forest, interspersed with open and naked plains, called prairies^ 
which are numerous west of the Alleghanies, but very rare on the Atlantic side. 
The country west of the Mississippi is comparatively lightly wooded; and in 
the arid and desert plains, occupying a breadth of 300 or 400 miles, only a few 
trees are seen along the margins of the rivers. In that portion of the United 



1842.] Forry on the Climate of the United States. 113 

States which is inhabited, the land cleared and cultivated does not probably ex- 
ceed one-tenth part of its surface." 

Various portions of the United States and territories present charac- 
teristics sufficiently marked to justify a division and classification of cli- 
mates. But previous to considering the local circumstances which exert 
modifying influences, we think it proper to invite attention to what we 
regard as the great principle of climatology. 

If the phenomena of terrestrial and atmospheric temperature which con- 
stitute the most prominent elements of climate, depended solely upon the 
position of the earth in relation to the sun, then would there be such a uni- 
formity in the climates of countries in similar latitudes as to render it easy 
to classify them according to their respective distances from the equator or 
proximity to the poles. But observations made in different parts of the 
world show that in similar latitudes climates differ greatly, as is exempli- 
fied on the two sides of the northern Atlantic, where the mean tempera- 
tures of places on or near the ocean are found to differ in some cases 10 
degrees of Fahrenheit, the climate of the European coast being that much 
warmer than the American in the same latitude. When, instead of mean 
temperatures, extremes of heat and cold are compared, the difference is 
still more striking. 

Now, in explaining the rationale of this well known fact, we are com- 
pelled to refer to a grand natural phenomenon, which we shall designate 
the great Atmospheric circulation. This commences in the tropical region 
where the accumulated heat of the sun rarefies the air, which, ascending 
into the higher regions of the atmosphere, flows off towards the North and 
South. To compensate for the loss by this successive flowing off of the 
heated and rarefied portion, and maintain that equilibrium which the baro- 
meter informs us always subsists in the atmosphere throughout the globe, 
lower currents of heavier air sweep into the tropical regions from the 
northward and southward. These last have been denominated the polar 
currents, whilst the uppermost are designated as the tropical currents; and 
these, it is well known, do not flow directly north or south, but slantwise, 
a fact which is ascribed to the influence exerted by the motion of the globe 
upon its axis, and the diflerent velocities existing at different parts of its 
surface. Owing therefore to the combined agencies of solar heat, and 
diurnal rotation, the lower winds in the equatorial region have a slanting 
direction from the eastward constituting the Trade Winds, which blow the 
year round between the tropics, except where changed into Monsoons by 
the interposition of some influences by which a change is wrought in their 
direction during six months of the year. Whilst the winds within the 
tropics thus blow interminably from the eastward, those without the tro- 
pical limits have a prevailing direction from the west. Here then we find 
the solution of the problem, that in extra-tropical latitudes all countries 
situated to the eastward of seas or other great bodies of water, have milder 
climates than those occupying the eastern portions of continents. Large 
bodies of water never become so cold in winter or so warm in summer as 
the earth. Hence whenever the predominant winds sweep from the sea, 
they carry with them the temperature of the water to a greater or less 
distance inland, and thus obviate extremes. When, however, the pre- 
vailing winds pass over large tracts of country, they must necessarily bear 
with them the greater or less degrees of cold induced by congelation, and 

10* 



114 Reviews, [July 

still more through radiation, whilst in summer they will convey the accu- 
mulated heat absorbed by the earth. This view enables us to understand 
why the proximity of the Gulf Stream, — that mighty lake of warm water, 
as Major Reynell calls it, not inferior in size to the Mediterranean, — does 
not shed upon the shores of the United States a larger portion of its 
high temperature, the greatest proportion of the warmth communicated by 
it to the atmosphere being actually wafted to the distant shores of Eu- 
rope. 

The celebrated Humboldt, who has devoted so much attention to the 
investigation of climate, and especially to the laws and agencies concerned 
in the distribution of heat over the surface of the globe, has formed a system 
of lines of equal temperature encircling the globe, and passing through places 
having the same mean temperature, either throughout the year or during 
particular seasons. Those passing through places having similar annual 
means are called isothermal lines. As, however, it is frequently found 
that where the annual temperatures agree there is a great difference in the 
means of particular seasons, other lines have been drawn to show this, 
such as pass through places having equal summer temperatures being 
called isotheral, and those representing equal winter means isocheimal 
lines. 

These lines, which from their generally crooked forms are also called 
curves^ demonstrate to the eye in a striking manner the well known fact, 
that the distribution of temperature on both sides of the equator is by no 
means in exact conformity to latitude or distance from the equinoctial line. 
Let us, for example, take Humboldt's isothermal line drawn through 
different points around the globe, having a mean annual temperature 
of 55°. 40 Fahr., and we shall find it in the eastern part of North Ame- 
rica passing near Philadelphia, in lat. 39°. 56; in the eastern part of 
Asia, near Pekin, in the same latitude with Philadelphia; whilst on the 
w'estern side of Europe it runs near Bourdeaux, in lat. 45''. 46; and on the 
western coast of N. America, it is found at Cape Foul weather, a little 
south of the mouth of the Columbia river, latitude 44°.40. Between the 
western part of Europe and the eastern portion of N. America, the follow- 
ing differences in mean temperature are found in similar latitudes, the 
increase in latitude being attended by a very great increase in the difference 
of the means: 



latitude. 


Mean Temp, of E. 


Mean Temp. Western 


Differences in 




coast of N. Am, 


coast of Europe. 


mean temp. 


30° 


66°.92 


70°.52 


3°.60 


40° 


54°.50 


63°.14 


8°.64 , 


50° 


37°.94 


50°.90 


12°.96 


60° 


23°.72 


40°.60 


16°.92 



Now all the great variations in the lines of equal temperature are 
mainly dependent upon the operation of those extensive natural move- 
ments which we have styled the great atmospheric circulation. " The 
causes of climate," our author remarks, " constitute together a circle of 
which we can designate neither the first nor the last concatenation." For 
ourselves, we find no difficulty in determining what may be considered 
the beginning link of the chain connecting nearly all the grand phenomena 
of climatology, which is doubtless the atmospheric rarefaction induced in 
the equatorial region through solar influence. 



1842.] Forry on the Climate of the United States. 115 

After this consideration of the great general agent in the production of 
climate, we will proceed to notice a few of those circumstances which are 
well known to exert more or less important effects upon the distribution 
of heat. One of the principal of these, is elevation above the level of the 
sea. Meteorologists compute that the temperature of the atmosphere falls 
off or grows colder in ascending above tide-water, at the rate of 1° Fahr. 
for every 100 yards, or 300 feet. In cool countries it would require, even 
in summer, but a slight ascent to reach the elevation where a temperature 
at and above 32°, fixes the line of perpetual congelation. But in warm 
regions, such as those within or bordering upon the tropics, the line of 
perpetual snow is elevated some 14,000 or 16,000 feet above the level of 
the ocean. 

Whenever land rises high above the common sea-level, it induces a 
change of climate similar in its effects upon the distribution of tempera- 
ture, and the consequent distribution of plants, to increase of latitude. 
The phenomena thus induced upon the products of the vegetable world 
are strikingly exhibited in the stupendous mountains which in central 
America tower above the common level of the ocean. 

In reference to the diminution of temperature resulting from the eleva- 
tion of land, our author makes the following interesting observations. 

" Whilst the flowers of spring are unfolding their petals on the plains of 
northern France, winter continues his icy reign upon the Alps and Pyrenees. 
By this beneficent appointment of nature, the torrid zone presents many habita- 
ble climates. On the great table-plain of Mexico and Guatimala, a tropical is 
converted into a temperate clime. As the vernal valley of Quito lies in the 
same latitude as the destructive coasts of French Guiana, so the interior of Af- 
rica may possess many localities gifted with the same advantages. In our own 
country, reference has already been made to the marked contrast between the 
Atlantic plain and the parallel mountain ridges; but it is in the geographical 
features of Columbia, in South America, that we find most strikingly displayed 
the physical phenomenon of height producing the effect of latitude — a change of 
climate with all the consequent revolutions of animal and vegetable life, induced 
by local position. It is on the mountain slopes of from 3,000 to 7,000 feet, 
beyond the influence of the noxious miasmata, that man dwells in perpetual 
summer amid the richest vegetable productions of nature. In the mountains of 
Jamaica, at the height of 4,200 feet, the vegetation of the tropics gives place to 
that of temperate regions; and here, while thousands are cut off annually along 
the coast by yellow fever, a complete exemption exists. In these elevated re- 
gions, the inhabitants exhibit the ruddy glow of health which tinges the counte- 
nance in northern climes, forming a striking contrast to the pallid and sickly 
aspect of those that dwell below. In ascending a lofty mountain of the torrid 
zone, the greatest variety in vegetation is displayed. At its foot, under the 
burning sun, ananas and plantains flourish; the region of limes and oranges suc- 
ceeds; then follow fields of maize and luxuriant wheat; and still higher, the 
series of plants known in the temperate zone. The mountains of temperate re- 
gions exhibit perhaps less variety, but the change is equally striking. In the 
ascent of the Alps, having once passed the vine-clad belt, we traverse in suc- 
cession those of oaks, sweet chesnuts, and beeches, till we gain the region of 
the more hardy pines and stunted birches. Beyond the elevation of 6,000 feet, 
no tree appears. Immense tracts are then covered with herbaceous vegetation, 
the variety in which ultimately dwindles down to mosses and lichens, which 
struggle up to the barrier of eternal snow. In the United States proper, we 
have at least two summits, the rocky pinnacles of which shoot up to the altitude 
perhaps of 6,500 feet. Of these. Mount Washington, in New Hampshire, is 
one. Encircling the base is a heavy forest— then succeeds a belt of stunted firs 
— next a growth of low^ bushes— and still further up only moss or lichens, or 



no Reviews. [July 

lastly, a nnked surface, the summits of which are covered, during ten mortths 
of the year, with snow. Of the snow-capt peaks of Oregon, we possess no pre- 
cise knowledge." 

It has, however, been ascertained that the decline of temperature on 
rising above the common level of the sea, and which is commonly reck- 
oned at 1° for every 300 feet of elevation, is less where large tracts of 
country rise gradually than when the estimate is made either by balloon 
ascension, or scaling the sides of isolated and precipitous mountains. A 
striking illustration of this is offered by the ridges and valleys of the great 
Himmaleh mountains of Southern Asia, where immense tracts, which 
theory would consign to the dreariness of perpetual congelation, are found 
richly clothed in vegetation and abounding in vegetable and animal life. 
At the village of Zonching, 14,700 feet above the level of the sea, in lat. 
31°. 36 N. Mr. Colebrook found flocks of sheep browsing on verdant 
hills; and at the village of Pui, at about the same elevation, there are pro- 
duced, according to Captain Gerard, the most luxuriant crops of barley, 
wheat, and turnips, whilst a little lower the ground is covered with vine- 
yards, groves of apricots, and many aromatic plants. 

The efiects of gradual elevation in lessening the falling ofT of temperature, 
is manifested upon a moderate scale in our own country. The mean tem- 
])erature of Eastport, Me., for example, is 42°. 95, whilst that of Fort 
Snelling in the same latitude, but far in the interior, with an elevation of 
some 600 or 800 feet above the sea, is 2°. 88 higher, namely, 45°. 83, in- 
stead of being two or three degrees colder, to correspond with the law of 
elevation. 

In regard to the extremes of heat and cold in the United States, it would 
be natural to expect the greatest heat would be registered at the most south- 
erly, and the severest cold at the most northern posts. But the exact in- 
strumental observations now furnished, prove this not to be the case, 
especially in the vicinity of the sea, where it would seem the proximity of 
water tends to moderate the heat of summer in the south, and the cold of 
winter in the north. It is in some of the western regions, remote from 
the ocean and inland seas, those for example, in which Forts Siiellijig, 
Gibson, and Council Bluffs, are situated, that the mercury rises highest 
and sinks the lowest. On the I5th of August 1834, at Fort Gibson, two 
thermometers observed by Dr. Wright of the army, rose in the shade, 
carefully excluded from reflected or radiated heat, the one to 116°, and the 
other to 117° Fahrenheit. 

It is a law applicable to all parts of the world, wherever no inland lakes 
or seas exist, to interpose a modifying influence, — that on leaving the 
coast and going into the interior, the difference between the mean tem- 
perature of summer and winter increases, the climates being more subject 
to extremes of heat and cold. To show that no exception to this law is 
furnished in the United States, we may adduce the instance of Fort Sul- 
livan, Eastport, Me., on the ocean in lat. 44°. 44, where the winter mean 
temperature is 17°45 Fahrenheit above that of Fort Snelling in Iowa, the 
latitude being the same. The climate of Fort Snelling, our author informs 
us, is the most excessive among all the military posts in the United States, 
resembling that of Moscow in Russia, as regards the extremes of the 
seasons, notwithstanding the latter is 11° further north. But at Moscow 
the mean temperature both of winter and summer is lower, — that of 
winter being as 10°.78 to 15°, 95, and that of summer as 97.° 10 to 



L.owcst 


Annual Range. 


2° 


83° 


10° 


106° 


16° 


120° 



1842.] Forry on the Climate of the United States. 117 

72°75. That the influence of the lakes in modifying the climate in their 
vicinities is not less than that of the ocean, is demonstrated by a com- 
parison of the summer and winter means of posts situated near them in 
about the same latitude. The difference between the mean temperature of 
summer and winter at Fort Preble, on the Atlantic, is 41°. 03, and of Fort 
Niagara on Lake Ontario, 41°. 73. At the excessive post, Fort Crawford, 
Wiskonsin, a few minutes further south than the two places first men- 
tioned, the difference amounts to 50°. 89. Again, a comparison of the 
difference between the winter and summer means of some other posts 
situated in the same latitude shows the following results, by which the 
increase in extremes on going west is strikingly demonstrated. The dif- 
ference between the mean temperature of summer and winter at Fort 
Wolcott, Newport, Rhode Island, is 36°. 55; at West Point, N. Y. 40°. 
75; Fort Armstrong, Illinois, 49°. 05; and at Council Bluffs, near the 
junction of the rivers Platte and Missouri, 51°. 35. The highest, lowest, 
and annual range of the thermometer at three of the posts just mentioned 
is as follows: — 

Highest 
Fort Wolcott, Newport, R. I. 85° 
Fort Armstrong, Illinois, 96° 

Council Bluffs, 104° 

Although the mean temperatures of winter on the sea-coast, is 6° 
higher, and of summer, 8°. 7 1 lower than in places situated on the same 
parallel in the interior beyond the influence of the lakes, the means of 
spring are 4.°13, and of autumn 0°.40, higher in the interior situations. 
This is the result of a comparison made in the latitude of about 43°. 

How strongly are all these views of the eastern climate of the United 
States contrasted with the equable temperature found in the Pacific region. 
At Fort Vancouver, for example, situated on the Columbia river, about 75 
miles above its mouth, the difference between the winter and summer 
means is only 23°. 67, although a degree farther north than Fort Snelling, 
five degrees more northerly than New York, and nearly on the same 
parallel with Montreal. During a year passed at Fort Vancouver, the 
lowest fall of the thermometer was to 17°. On nine days only was the 
temperature below the freezing point in the month of January, so that 
ploughing is carried on whilst the vegetables of the preceding season are 
still standing in the gardens untouched by frost. And why does not New 
York, situated directly on the Atlantic ocean, derive as much warmth from 
this magazine of heat, as Fort Vancouver does from the more distant Paci- 
fic? Simply because the predominant westerly winds sweep upon one 
place the chilling blasts of extensive districts of land, cooled to congela- 
tion, or covered with snow, whilst over the other they waft the genial 
warmth of the sea. For similar reasons the ameliorations of climate expe- 
rienced in the vicinity of the interior lakes, must always be felt most to 
the eastward. 

The classification of climates distinguished by Dr. Forry in the 
United States and territories, is founded upon a general division into 
Northern, Middle and Southern regions; the first being characterized by 
the predominance of a low mean temperature, the Southern by a high tem- 
perature, and the Middle vibrating to both extremes. Each of these 
general divisions is subdivided into classes or systems sufficiently marked. 



118 Reviews, \J^^Y 

The Northern System has three classes, ihe first embracing the coast 
of New England, extending as far south as the harbour of New York; 
the second including the districts in the proximity of the Northern lakes; 
the third, portions of country alike remote from the ocean and inland seas. 

The Middle division has two classes, \he first embracing the Atlantic 
coast from Delaware Bay to Savannah; the second, interior stations. 

The Southern division has also two classes, the first including those 
parts in which the military posts on the Lower Mississippi are situated, 
and the second the peninsula of East Florida. 

It is the Northern region which presents at the same time the greatest 
diversity of physical character and the most strongly marked variations in 
climate. East of the great lakes the several mountain ranges seldom ex- 
ceed the height of 2500 feet above the level of the sea — the table-lands 
upon which the ridges rest rising perhaps, on an average, to half the height 
named. We have already adverted to the fact, that on ihe coast of New 
England, the influence of the ocean is manifested in moderating extremes 
of temperature. Advancing into the interior the extreme range of the 
thermometer increases, and the seasons are violently contrasted, until get- 
ting within the influence of the lakes, when a climate like that of the sea- 
board is found. That the lakes have this capacity to modify the climate 
in their vicinity will be evident to any one who considers that they occupy 
not less than 94,000 square miles, having a depth varying from 20 to 500 
feet. Beyond the modifying agency of these inland seas, temperatures 
still more excessive are exhibited, a comparative view of which, including 
exact estimates for the sea-coast and regions of and beyond the great lakes, 
has been already given. 

When the climates on the sea-coast and interior country remote from the 
lakes are compared in relation to the proportions o^ fair and cloudy wea- 
ther, rain and snoiv, the following results appear. During the year, the 
proportion o^ fair days on the sea-coast compared to those of the interior, 
are as 202 to 240 — cloudy days 108 to 77; — rainy days 45 to 31; snowy 
9 to 16. 

Comparing the climate of the lakes with that of the same region be- 
yond their influence, the contrast is yet more striking, the prevailing wea- 
ther of the former being cloudy, and the latter fair; thus, during the year, 
the proportion of days is. 



Fair. 


Cloudy. 


Rain. 


Snow 


Lakes, 117 


139 


63 


45 


Remote from Lakes, 216 


73 


46 


29 



The relative proportion of rainy and cloudy days during the year is, 
therefore, in the former locality 247, and in the latter 148, giving the far 
west about 100 more sun-shiny days out of the annual sum of 365. 

Thus much for the Northern division. 

\\\ considering the climate of the middle division of the United States, 
our author thinks himself justified by the results of the meteorological ob- 
servations in his possession, in distinguishing two classes, designated as 
uniform and excessive climes, the first being slightly under the influence 
of the Atlantic Ocean, whilst the southwestern stations show the powerful 
influence of the Gulf of Mexico. 



1842."] Forry on the Climate of the United States, 119 

In proceeding south, the seasons, as a general rule, appear more uni- 
form, the annual mean temperature increasing as a matter of course. Some 
of the eastern posts in this middle division present such great contrasts be- 
tween their summer and winter temperatures, as almost to place them in 
the list of excessive climes. The modifying influence of the adjacent 
ocean and bays are however still apparent, since farther westward on the 
same parallels, greater extremes are common. 

" The region of Pennsylvania, as though it were the battle ground on which 
Boreas and Auster struggle for mastery, experiences, indeed, the extremes of 
heat and cold. But proceeding south along the Atlantic Plain, climate soon 
underdoes a striking modification, of which the Potomac river forms the line of 
demarcation. Here the domain of snow terminates. Beyond this point, the 
sledge is no more seen in the farmer's barnyard. The table-lands of Kentucky 
and Tennessee, on the other hand, carry, several degrees farther south, a mild 
and temperate clime. Although very few thermometrical observations have 
been made upon the table-land lying in the centre of the middle division or upon 
the ridges which crest this long plateau, thus rendering it impracticable to de- 
termine fully the interesting question of their influence upon temperature; yet 
we are enabled to supply this deficiency, in some measure, by observations 
made upon the differences in vegetable geography. Thus in Virginia, as the 
limits of the state extend quite across the Apalachian chains, four natural divi- 
sions are presented, viz., 1. The Atlantic Plain or tide-water region, below the 
falls of the rivers; 2. The Middle region, between the falls and the Blue Ridge; 
3. The Great Valley, between the Blue Ridge and the Alleghany Mountains; 
and 4. The Trans-Alleghany region, west of that chain. In each of these, the 
phenomena of vegetation are modified in accordance with the climatic features. 
On the Atlantic Plain, tobacco is the principal staple; in the Great Valley, it is 
cultivated only in the southern portion; and beyond the Alleghany, its culture 
is unknown. In the first only is cotton cultivated, and in its southern part 
quite extensively. In North Carolina, the Atlantic Plain extends 60 or 70 miles 
from the coast, whilst the Middle region, corresponding to that described in 
Virginia, gradually merges into the mountainous regions farther west. As 
these table-lands are elevated from 1,000 to 1,200 feet above the sea, upon 
which rise many high crests, one of which (Black Mountain) is the highest 
summit of the Alleghany system, the diversity of climate on the same parallels 
causes a corresponding difference in the vegetable productions. Whilst the 
low-lands yield cotton, rice, and indigo, the western high country produces 
wheat, hemp, tobacco, and Indian corn. In South Carolina, three strongly 
marked regions are also presented; but as the temperature increases, as a gene- 
ral law, in proportion as we approach the equator, cotton is cultivated through- 
out the state generally. Georgia, Alabama, and Mississippi, like the Caroli- 
nas, are divided into three well defined belts, exhibiting similar diversities in 
vegetable geography. Cotton and rice, more especially the former, are the 
great agricultural staples; and on the Atlantic Plain of these three states, as 
well as its continuation into Florida and Louisiana, (which last two will be 
more particularly adverted to in the southern division,) sugar may be advan- 
tageously cultivated. In North Carolina and Virginia, the Atlantic Plain 
forms, as it were, a chaos of land and water, consisting of vast swamps, traversed 
by sluggish streams, expanding frequently into broad basins with argillaceous 
bottoms. Throughout its whole extent, as already remarked, it is characterized 
by similar features, besides being furrowed with deep ravines in which the 
streams wind their devious way. The hot and sultry atmosphere of these low- 
lands, in which malarial diseases in every form are dominant, contrasts strongly 
with the mild and salubrious climate of the mountain regions— results that will 
be developed more fully in the investigation of endemic influences. 

" It may not be amiss, as illustrative of the comparative temperature of the At- 
lantic Plain and the adjacent mountain region, to present here a few thermorae- 



120 



Reviews. 



[July 



trical data, however limited in extent, noted, during the summers of 1839 and 
1840 at Flat Rock, Buncombe county. North Carolina. 



Places of Observation. 


Lat. 


Me;<n Temperature. 


July. 1 Aug. 1 Sept. | Oct. 


Fort Monroe, Coast of Virginia, 
Flat Rock, Buncombe, N. C, 
Charleston, South C;irolina, 


370.00 
350.30 

320.45 


8O0 
690 
8I0 


700 
700 

8I0 


720 
62° 

770 


64° 
61° 
71° 



" Flat Rock is about250 miles from the Atlantic, and is elevated perhaps 2,500 
feet above the level of the ocean, whilst the latitude given is also a mere approxi- 
mation derived from general knowledge. The observations made at Charleston 
embrace the same years as those at Flat Rock, but the data at Fort Monroe com- 
prise the years 1828, 29, and 30. It is thus seen that the difference of tempera- 
ture at Flat Rock and the other two points, taking an average of the latter, is in 
July 11°, August 10°, September 13°, and October 6°. As regards the monthly 
range of the thermometer, little difference is presented." 

Although the general inquirer may find most interest in considering the 
phenomena connected with climatology in the two first general divisions of 
the United States, the medical inquirer will attach the most importance to 
the characteristics of the southern region, as this presents the most for- 
midable array of diseases, and at the same time holds out a refuge to vale- 
tudinarians who could not long resist the combined pressure of disease 
and a rigorous northern winter clime. 

Along the Atlantic coast of the United States, the mean temperature of 
the year diminishes in a very unequal ratio. Between Charleston and 
Philadelphia, the difference of means is 10^° Fahr., or in the proportion of 
about 1^° of temperature to 1° of latitude. Between Philadelphia and 
Eastport, Maine, the difference in means is much greater, namely, 12°. 33 
Fahr. being in the increased proportion of nearly 2°. 5 of mean tempera- 
ture per degree of latitude. Again, between Charleston, S. C, and New 
York harbour, the difference of means is 12°. 78, or 1°.59 per degree of 
latitude. Between New York harbour and Eastport, Maine, the differ- 
ence is 11°, or about 2|° Fahr. per degree of latitude. The average pro- 
portion between Charleston, S. C., and Eastport, Maine, is equal to about 
2° of temperature for each degree of latitude. 

In approaching south, the extremes of winter and summer grow less, 
and the seasons glide more imperceptibly into' each other. At Fort Snel- 
ling, situated in the excessive climate of the west, in latitude 44°. 53, the 
difference between the summer and winter means is, as has been before 
stated, no less than 56°. 60; at Eastport, Maine, 39°. 15, at West Point, 
N. Y., 40°.75, at Charleston, S. C, 30°. 34, at St. Augustine, Florida, 
20°, whilst at Key West, it is only 11°. 34. 

"There is," says Dr. Forry, "little difference between the thermometrical 
phenomena presented at Key West and the Havana. In the West India islands, 
the mean annual temperature near the sea is only about 80°. At Barbadoes, the 
mean temperature of the seasons is — winter, 76°, spring 79°, summer 81°, and 
autumn 80°. The temperature is remarkably uniform; for the mean annual 
range of the thermometer, even in the most excessive of the islands, is only 13°, 
and in some it is not more than 4°.* Contrast this with Hancock Barracks, 
Maine, which gives an average annual range of 118°, Fort Snelling, Iowa, 119°, 
and Fort Howard, Wiskonsin, 123°! 

"The peculiar character of the climate of East Florida, as distinguished from 

* According to the British Army Statistics. 



1842.] Forry on the Climate of the United States. 121 

that of our more northern latitudes, consists less in the mean annual tempera- 
ture than in the manner of its distribution among the seasons. At Fort Snel- 
ling-, for example, the mean temperature of winter is 15°. 95, and of summer 
72°. 75, whilst at Fort Brooke, Tampa Bay, the former is 64°. 76, and the latter 
84°.25, and at Key West, 70°.05, and 81°.39. Thus though the winter at Fort 
Smelling is 54*^.10 colder than at Key West, yet the mean temperature of sum- 
mer at the latter is only 8°. 64 higher. In like manner, although the mean 
annual temperature of Petite Coquille, Louisiana, is nearly 2° lower, that of 
Augusta Arsenal, Georgia, nearly 8°, and that of Fort Gibson, Arkansas, up- 
wards of 10° lower than that of Fort Brooke; yet at all, the mean summer tem- 
perature is higher. Between Fort Snelling on the one hand, and Fort Brooke 
and Key West on the other, the relative distribution of temperature stands thus: 
Difference between the mean temperature of summer and winter at the former 
56°. 60, and at the two latter 16°. 49 and 11°. 34; difference between the mean 
temperature of the warmest and coldest month, 61°. 86 compared with 18°. 66 
and 14°. 66; difference between the mean temperature of winter and spring, 
30°.83 to 8^.35 and 5°.99; and the mean difference of successive months, 10°.29 
to 3°.09 and 2°. 44." 

A comparison in regard to equality and mildness of climate drawn be- 
tween the seasons of Florida and those of the most favoured places on the 
European continent, those of Italy and southern France, results generally 
in favour of the Florida Peninsula. At Key West the annual range of the 
thermometer is but 37^. The advantages East Florida presents to invalids 
as a winter residence, are therefore very obvious. 

The question has been much debated, whether the temperature of the 
crust of the earth or of the incumbent atmosphere has undergone any per- 
ceptible changes since the earliest records, either from the efforts of man 
in clearing away forests, draining marshes, cultivating the ground, or other 
causes. La Place has demonstrated very satisfactorily, that since the days 
of Hipparcus, an astronomer of the Alexandrian school, who flourished 
about 2000 years ago, the earth cannot have become a single degree of 
heat warmer or colder, as otherwise the sidereal day must have become 
either lengthened or shortened, which is not the case. 

As to the question of changes in atmospheric temperature affecting 
the seasons, M. Arago thinks that sufficient proofs exist to justify the con- 
clusion that in Europe, at least, a sensible elevation of the annual mean 
temperature has resulted from the conquests of agriculture. The thermo- 
meter is comparatively a modern instrument, invented by Galileo in 1590, 
but still left so imperfect, that it was not till 1700 that Fahrenheit suc- 
ceeded in improving and rendering it a correct and perfect instrument. It 
is evident that the want of exact instrumental observations prior to the 
commencement of agricultural improvements must render it extremely dif- 
ficult to determine with any precision, what changes may have been ef- 
fected through these in the mean temperatures of the year or particular 
seasons. Hence, notwithstanding the expression of his belief in the 
changes of atmospheric temperature, M. Arago looks to America for the 
necessary data by which the point must be definitely settled. 

"Ancient France," he remarks, "contrasted with what France now is, pre- 
sented an incomparably greater extent of forests; mountains almost entirely 
covered with wood, lakes and ponds, and morasses, without number; rivers 
without any artificial embankment to prevent their overflow, and immense dis- 
tricts, which the hands of the husbandman had never touched. Accordingly, 
the clearing away of the vast forests, and the opening of extensive glades in 
No. VII.— July, 1842. 11 



122 Reviews. [July 

those that remain; the nearly complete removal of all stagnant waters, and the 
cultivation of extensive plains, which thus are made to resemble the stepes of 
Asia and America — these are among the principal modifications to which the 
fair face of France has been subjected, in an interval of some hundreds of years. 
But there is another country which is undergoing these same modifications at 
the present day. They are there progressing under the observation of an en- 
lightened population; they are advancing with astonishing rapidity; and they 
ought, in some degree, suddenly to produce the meteorological alterations which 
many ages have scarcely rendered apparent in our old continent. This country 
is North America. Let us see, then, how clearing the country affects the cli- 
mate there. The results may evidently be applied to the ancient condition of 
our own countries, and we shall find that we may thus dispense with a priori 
considerations, which, in a subject so complicated, would probably have mis- 
led us." 

There is great force in the following remarks of Dr. Forry, and the 
facts adduced in their support: 

" Dense forests and all growing vegetables doubtless tend considerably to 
diminish the temperature of summer, by affording evaporation from the surface 
of their leaves, and preventing the calorific rays from reaching the ground. It 
is a fact equally well known that snow lies longer in forests than on plains, be- 
cause, in the former locality, it is less exposed to the action of the sun; and 
hence, the winters, in former years, may have been longer and more uniform. 
As the clearing away of the forest, causes the waters to evaporate and the soil 
to become dry, some increase in the mean summer temperature, diametrically 
contrary to the opinion of Jefferson and others, necessarily follows. It is re- 
marked by Umfreville that, at Hudson's Bay, the ground in open places thaws 
to the depth of four feet, and in the woods to the depth only of two. More- 
over, it has been determined by thermometrical experiments that the tempera- 
ture of the forest, at the depth of twelve inches below the surface of the earth, 
is, compared with an adjacent open field, at least 10° lower, during the summer 
months; whilst no difference is observable during the season of winter. 

"It may, therefore, be assumed, that although cultivation of the soil may not 
be productive of a sensible change in the mean annual temperature, yet such a 
modification in the distribution of heat among the seasons may be induced as 
will greatly influence vegetation." 

Bearing upon this point. Dr. Forry furnishes a table exhibiting a compa- 
rative view of the atmospheric temperature at Philadelphia, at intervals of 
about a quarter of a century, (from 1771 to 1824,) which shows a succes- 
sive decrease in the mean of winter, and an increase in the means of 
spring, summer, autumn, and whole year.* Some allowance must be 
made in these estimates for the effects of increase in the size of the city, 
and the additional shelter in winter, and opportunity of accumulating heat 
in summer thus afforded. All towns are observed to grow warmer as they 
extend their limits. When, therefore, we fiind a decline in the mean tem- 
perature of winter, notwithstanding the extension of the city limits, we 
must infer that it can arise from no other cause than a general diminution 
in the winter temperature throughout the country. 

Any changes in the climate of the United States as yet perceived, are 
very far from justifying the sanguine calculations indulged in a few years 

* The 6th volume of Transactions of the American Philosophical Society, new 
series, contains an abstract of meteorological tables, showing the temperature at Phi- 
ladelphia for 80 years from 1758 to 1833, giving the mean of each month, the annual 
mean; and the greatest and least degrees of heat; the last part of the series, embracing 
the period from 1829 to 1838, by Dr. Thomas T. Hewson. 



1842.] Kighy's System of Midwifery, 123 

ago by a writer on the climate and vegetation of the fortieth degree of 
North latitude,* who, in concluding his essay, says: 

"But there will doubtless be an amelioration in this particular," (seve- 
rity of cold) " when Canada and the United States shall become thickly 
peopled and generally cultivated. In this latitude, then, like the same 
parallels in Europe at present, S7io?v and ice ivill become rare phenomena, 
and the orange, the olive, and other vegetables of the same class, now 
strangers to the soil, ivill become objects of the labour and solicitude of 
the agriculturist^ 

Had this writer extended his inquiries a little further, he might have 
found that the region of Oregon, lying west of the Rocky Mountains, 
though as yet in a primitive state of nature, has a climate even milder than 
that of highly cultivated Europe in similar latitudes. And again, China, 
situated precisely under the same conditions as the United States in regard 
to the sea, though long since subjected to the highest state of agricultural 
improvement, possesses a winter climate as rigorous, and some assert 
even more so, than that of the United States in similar latitudes. 

There are many points considered by our author which it would have 
given us pleasure to have noticed more particularly. We have endeavoured 
to follow him through the main course of his investigation, and when it is 
considered that the facts and views he presents are original, and the results 
of years of observation and severe mental toil, upon subjects essentially 
connected with medical inquiries, we hope we shall not be considered as 
having gone out of the track of our professional readers, or trespassed too 
much upon their valuable time. 

G. E. 



Art. XII. — A System of Midwifery, ivith numerous wood cuts. By 
Edward Rigby, M. D., &:c., with Notes and additional illustrations. 
Philadelphia, Lea & Blanchard, 1841: 8vo. pp. 491. 

We know of no series of treatises, devoted to a consideration of the dif- 
ferent branches of medical science, the character of which has been so 
uniformly sustained as that which composes the several volumes of Twee- 
die's Library of Medicine. If the successive portions of the work do not 
actually exceed in value those which preceded, they, at least, in no in- 
stance sink below them; — while the whole, so far as published, presents a 
very able, and generally speaking, full and accurate exposition of the actual 
condition of the healing art, as well in relation to its principles as to its 
practical details. 

The volume before us, which embraces the obstetrical department of 
the Library, will command a high rank among the numerous systems of 
midwifery that have appeared within the few past years, bearing the names 
of some of the most distinguished cultivators of the obstetric art. 

While the author has made free use of the labours of his predecessors 
and contemporaries, he has not confined himself to the humble task of a 

* Remarks on the Climate and Vegetation of the fortieth degree of North latitude. 
By Richard Sexton, M. D., published in the 5th volume of this Journal; a paper con- 
taining many highly interesting observations upon the Climatology of the United 
States. 



124 Reviews, [July 

mere compiler, but has skilfully woven into a continuous narrative those 
principles and rules of practice in the department of which he treats, that 
have become the common property of the profession, giving, at the same 
time, to the facts and directions he details a sanction and authority derived 
from his own personal experience and observation. 

The great object at which Dr. Rigby appears to have aimed, is perfect 
accuracy, with as great a degree of conciseness as was compatible with a 
clear exposition of every important point connected with his subject; and 
in the attainment of this, he has been enabled to present to the profession 
a work, equally valuable as a manual for the use of the obstetrical student, 
and a compendium of the experience of the whole profession by which 
the practitioner may compare and correct the results of his own observa- 
tions. 

Notwithstanding the term Midwifery strictly speaking implies only the 
proper management of the process of parturition, Dr. Rigby extends it, 
in common with the major portion of modern writers, to " the knowledge 
and art of treating a woman and her child during her pregnancy, labour, 
and the puerperal state." 

The work commences with a short anatomico-physiological view of the 
structure, form, arrangement and functions of those parts and organs 
which are more or less directly concerned in the important processes of 
pregnancy and parturition. Then follow in succession the diagnosis and 
course of healthy pregnancy, and its various diseases, terminating with the 
subject of healthy parturition, and its treatment; parturition properly 
speaking comes under two separate heads, eutocia and dystocia, the one 
signifying natural or favourable labour, the other unnatural, faulty or un- 
favourable labour; and lastly, a short account is presented of some of the 
more important diseases which occur to the mother during the first month 
after parturition. 

The first part, as is stated above, treats of the anatomy and physiology 
of utero-gestation, embracing a very accurate and intelligible description of 
the structure, axes and diameters of the female pelvis, the anatomy of the 
female organs of generation, the phenomena consequent upon impregna- 
tion, and the history and development of the ovum. 

Without entering into a consideration of the various speculations that 
have been advanced by distinguished writers, in relation to the physiology 
of utero-gestation, the author presents a clear, concise, and instructive view 
of every well established fact connected with this interesting and important 
subject. 

In regard to the corpora lutea, in relation to which some misconception 
would appear still to exist, the following remarks of Dr. Rigby may not 
be without instruction to the few who continue to doubt their dependence 
upon successful impregnation. 

*' A Graafian vesicle cannot be converted into a corpus luteum except by ac- 
tual and effective sexual intercourse; and the strange and discrepant accounts 
which have every now and then been published, even by authors of consider- 
able repute, of corpora lutea having been found in the ovaries of virgin and 
even new^ly born animals, merely prove that the true characteristics of the corpus 
luteum were not sufficiently known. The irregular cysts, cavities or deposites 
of whitish or yellowish structure which are frequently found in the ovary, inde- 
pendent of impregnation, and which have been improperly enough called virgin 
corpora lutea, present points of difference so marked, that they can scarcely be 
mistaken by an experienced eye. The angular cavity opening externally, the 



1842.] "Righy's System of Midwifery. 125 

stellated, radiated, cicatrix-like appearance, which a section of the corpus lu- 
teum presents, its soft and delicate structure as described by Dr. Hunter, and, 
above all, its vascularity, and the facility with which its vessels can be injected 
from the general tissue of the ovary, are characters only found in a true corpus 
luteum. Virgin corpora lutea frequently occur under circumstances of disease, 
especially those of a tubercular character. They frequently appear as distinct 
cysts, the walls of vi^hich are semi-cartilaginous; at other times, they seem to be 
nothing more than a coagulum of blood: they seldom project much from the 
ovary, and in no instance have they the peculiar structure of the corpus luteum, 
nor the external cicatrix, nor are they capable of being injected." 

" When pregnancy is over, the corpus luteum gradually diminishes and disap- 
pears. Dr. Montgomery states that, 'the exact period of its tQtal disappearance 
I am unable to state, but I have found it distinctly visible so late as at the end 
of five months after delivery at the full time, but not beyond this period.' 
Hence it will be seen, that in a few months after the termination of pregnancy, 
all traces of the corpus luteum are lost, and that, therefore, it will be impossible 
to decide as to how frequently impregnation has taken place, merely by exam- 
ining the ovaries as has been supposed. There is another point to which Dr. 
Montgomery has alluded, which is well worthy of notice: in mentioning the 
fact, that a vesicle may contain two ova, and thus a woman be delivered of twins, 
and yet there be but one corpus luteum, he observes, that ' the presence of a cor- 
pus luteum does not prove that a woman has borne a child, although it would be 
a decided proof that she had been impregnated, and had conceived, because, it 
is quite obvious that the ovum after its vivification may be, from a great variety 
of causes, blighted and destroyed, long before the fcEtus has acquired any distinct 
form. It may have been converted into a mole or hydatids: thus, however para- 
doxical it may at first sight appear, it is nevertheless true, that a woman may 
conceive and yet not become truly with child, a fact already alluded to, as no- 
ticed by Harve)'; but the converse will not hold good. I believe no one ever 
found a foetus in utero without a corpus luteum in the ovary; and that the truth 
of Haller's corollary, ' nullus unquam conceptus est absque corpore luteo,' re- 
mains undisputed.' " 

The second part of the work treats of natural pregnancy and its devia- 
tions. The chapter on the signs of pregnancy exhibits much good sense, 
commendable caution, and sound discrimination. 

The difficulty, and at the same time, the great importance, in many 
cases, of arriving at a correct diagnosis of pregnancy are clearly and fully 
stated; while each of the phenomena consequent upon utero-gestation, as 
well the general effects it produces upon the system, as those changes and 
phenomena which are peculiar to this state, are individually described, and 
the absolute and relative importance of each carefully examined. The 
entire chapter is one of great merit. 

After showing the insufficiency of the major portion of those phenomena 
usually esteemed as indicative of pregnancy, the author remarks, 

" In reviewing what has now been stated respecting the diagnosis of preg- 
nancy, it will be observed, that we have enumerated four symptoms, which 
must be looked upon as perfectly diagnostic of this condition, and in the accu- 
racy and certainty of which we may place the fullest confidence: two may be 
recognised at an early period by means of auscultation, viz. the sounds produced 
by the movements of the foetus, and by the pulsations of its heart; the two others 
are not appreciable until a later period, and are afforded by manual examination, 
viz. the being able to feel the head of the foetus, per vaginam, and its move- 
ments through the abdominal parietes. The next in point of value after these 
are the changes in the os and cervix uteri, those connected with the formation of 
the areola in the breasts, and, at a somewhat later period, the sound of the ute- 
rine circulation; changes which, although they cannot separately be entirely de- 
ll* 



126 Revietas. [.■^^^Y 

pended upon, are nevertheless symptoms of very great importance in the diagno- 
sis of pregnancy." 

"Two other signs of pregnancy have also been mentioned, viz., the appear- 
ance of a peculiar deposite in the urine as described by M. Nauche, or rather 
by Savonarola, (Montgomery, Op. Cit.^ p. 157,) and the purple or violet appear- 
ance of the mucous membrane lining the vagina, and os externum, as described 
by Professor Kluge of the Charite at Berlin, and by MM. Jacquemin, Parent Du- 
chatelet, &c. of Paris. With regard to the first, which is an old popular symp- 
tom of pregnancy, there is too much variety in the appearances of the urine, 
depending on general health, diet, temperature, &c., to enable us to place much 
confidence in any change of this sort." 

"The purple colour of the vaginal entrance appears, from the extensive expe- 
rience of the above-mentioned authors, to be a pretty constant change produced 
by the state of pregnancy; it probably occurs at a very early period. How far 
a similar tinge is produced by the state of uterine congestion immediately before 
a menstrual period, we are unable to say; at any rate, the character of the exa- 
mination itself must ever be sufficient to preclude its being practised in this 
country." 

The ensuing chapter on the treatment of pregnancy, presents a concise, 
but judicious view of the remedies adapted to the removal of those dis- 
turbances of function and other affections so often consequent upon utero- 
gestation — and which, though in the ordinary run of cases they are very 
readily subdued, occasionally cause great distress to the patient, and in 
their management, demand no little skill and caution on the part of the 
practitioner. 

The signs of the death of the foetus are next considered, and a very 
lucid and able exposition is given of the phenomena resulting from the 
cessation of life in the child, as they occur before and during labour, with 
their individual and collective value. As Dr. Rigby very justly remarks — 

"There are few circumstances more painful to the feelings of an accoucheur, 
than the uncertainty as to whether the child be alive or dead, in a labour where 
the passage of the head is rendered unusually difficult or dangerous for the mo- 
ther, even with the aid of the forceps; whether the difficulty be produced by 
want of proportion between the head and pelvis, unusual rigidity of the os uteri, 
&c. Could he assure himself that it was alive, he would feel justified in either 
trusting still longer to the efforts of nature, or in applying the forceps, even 
although he knows that the delivery cannot be effected without considerable dif- 
ficulty and suffering: whereas, if he could once feel satisfied that the child had 
ceased to exist, he would have recourse to perforation, for the purpose of dimi- 
nishing the size of the head, and thus releasing the mother from the dangers of 
her situation." 

The following paragraph proposes an important consideration, which 
should be duly weighed by every practitioner of midwifery. 

"The increasing success which has attended the Cassarean operation of late 
years, adds still more to the importance of having the signs of the child's life or 
death in utero carefully investigated and understood; for under such circum- 
stances, it becomes a most serious question whether we are justified in destroy- 
ing the life of the foetus by perforation, when we might in all probability have 
saved it by resorting to another means of delivery, which, formidable as it is, is 
now infinitely less so than it was in former times. It becomes a question whe- 
ther we ought not, in certain cases, to adopt the same indications for performing 
the Cassarean operation, as are used upon the continent, and apply it not only to 
those cases where the child cannot be delivered per vias naturaies, but also to 
those cases of minor pelvic obstruction, where, if we could feel sure of the 
child's death, we should have recourse to perforation. Under circumstances of 



A 



1842.] Rigby's System of Midwifery, 127 

this nature, the question becomes one of fearful responsibility, the painfulness 
of which is not a little increased by the uncertainty as to whether the child be 
alive or not." 

The chapters on mole pregnancy, extra-uterine pregnancy, and retro- 
versing of the uterus, present a very comprehensive and admirable expo- 
sition of the actual state of our knowledge in relation to the causes, diag- 
nostic symptoms and proper management of these cases. It would be 
difficult to refer to any work in which will be found a more accurate and, 
at the same time, so clear and definite an account of either of the foregoing 
subjects, more especially one presented in so condensed a form as that in 
the volume before us. 

The duration of pregnancy is the subject of chapter seven. The grand 
question which this subject involves, whether, namely, a female can really 
go beyond the common period of gestation, receives that attention from 
the author which its importance merits. After pointing out the ordinary 
sources of error in computing the duration of pregnancy, especially the 
assumption of various and uncertain data by which to determine the mo- 
ment of conception, Dr. Rigby, from various considerations, concludes that 
the period of forty weeks, or ten lunar months, is most generally that of 
gestation in the human female; although for certain reasons connected with 
his view of the causes which determine the period at which labour usually 
comes on, he is inclined to believe it may occasionally fall short or exceed 
somewhat this period. 

"It is now," he remarks, "ten years ago since we first surmised, that *the 
reason why labour usually terminates pregnancy at the fortieth week, is from 
the recurrence of a menstrual period at a time during pregnancy, when the ute- 
rus, from its distension and Aveight of contents, is no longer able to bear that 
increase of irritability which accompanies these periods without being excited 
to throw off the ovum.' 

" Under the head of premature expulsion, we shall have occasion to notice 
the disposition to abortion, which the uterus evinces at what, in the unimpreg- 
nated state, would have been a menstrual period: for some months after the com- 
mencement of pregnancy, a careful observer may distinctly trace the periodical 
symptoms of uterine excitement corning on at certain intervals, and it may be 
easily supposed that many causes for abortion act with increased effect at these 
times. Where the patient has suffered from dysmenorrhoea before pregnancy, 
these periods continue to be marked with such an increase of uterine irritability 
as to render them for some time exceedingly dangerous to the safety of the ovum. 
Even to a late period of gestation, the uterus continues to indicate a slight in- 
crease of irritability at these periods, although much more indistinctly; thus, in 
cases of hemorrhage before labour, especially where it arises from the attach- 
ment of the placenta to the os uteri, it is usually observed to come on, and to 
return at what, in the unimpregnated state, would have been a menstrual period. 
We mention these facts as illustrating what we presume are the laws on which 
the duration of pregnancy depends, and also as being capable of affording a satis- 
factory explanation of those seeming over-term cases, which are occasionally 
met with. 

"From this view of the subject it will be evident, that the period of the men- 
strual interval at which conception takes place, will in great measure influence 
the duration of the pregnancy afterwards; that where it has occurred immediately 
after an appearance of the menses, the uterus will have attained such a dilatation 
and weight of contents by the time the ninth period has arrived, that it will not 
be able to pass through this state of catamenial excitement without contraction, 
or, in other words, labour coming on; hence it is that we find a considerable 
number of labours fall short of the usual time, so much so, that some authors 



128 Revieivs, [J"ly 

have even considered the natural term of human gestation to be 273 days, or 39 
weeks: for a somewhat similar reason we can explain why primiparae seldom go 
to the full term of gestation, the uterus being less capable of undergoing the neces- 
sary increase of volume in a first pregnancy than it is in succeeding ones. On 
the other hand, where impregnation has taken place shortly before a menstrual 
period, the uterus, especially if the patient has already had several children, will 
probably not have attained such a volume and development as to prevent its 
passing the ninth period, without expelling its contents, but may even go on to 
the next before this process takes place; it is in this way that we would explain 
the cases related by Dr. Dewees and Dr. Montgomery. We are aware, that 
under such a view of the subject, the duration of time between the catamenial 
periods of each individual should be taken into account, some women menstru- 
ating at very short and others at very long intervals; but although this will 
affect the number of periods, during which the pregnancy will last, it will not 
influence the actual duration of time, as this will more immediately depend upon 
the size and weight of contents which the uterus has attained." 

A very excellent and instructive chapter on the premature expulsion of 
the foetus — its causes, symptoms, and effects, together with the prophy- 
lactic and remedial measures to be pursued, closes the second part. 

The third part treats of Eutocia, or natural parturition. 

The first chapter contains a very full and admirable description of the 
coming on — the different stages — progress and termination of a case of 
natural labour — in the preparation of which the author acknowledges his 
frequent indebtedness to the works of Wigand {Geburt des Menschen,) 
and of Hohl [Die gehurtshulfliche Exploration). We are acquainted with 
no description of the phenomena of natural labour so well adapted for the 
instruction of the student — or one from an attentive perusal of which the 
young obstetrical practitioner will be able to glean so many useful hints. 

A very able chapter succeeds on the treatment of natural labour. The 
directions, in the highest degree judicious in themselves, are detailed with 
sufficient minuteness and clearness, and enforced by an exposition of the 
reasons upon which they are severally based. Few practitioners of the 
obstetric art remote from our larger cities, even though they may have de- 
voted years to the profession, will, we suspect, be found who will not 
derive much instruction from a careful study of this excellent chapter. 

In the ensuing chapter is considered the all important subject, the me- 
chanism of parturition, without a thorough acquaintance with which, 
no one is competent to take charge of any case of labour — this being the 
only true basis upon which the principles of practical midwifery can be 
founded. 

"Unless," as the author correctly remarks, "a practitioner be thoroughly 
acquainted with every step in the mechanism of a natural labour, how can he be 
expected to understand and detect with certainty any deviation from its usual 
course, still less make use of those means which may be required under the 
peculiar circumstances of the case; and yet strange to say, there are few sub- 
jects which, generally speaking, have excited so little attention, and upon which 
such incorrect opinions have prevailed even up to the present time." 

Dr. Rigby has endeavoured, in the chapter before us, to render this un- 
questionably difficult subject as clear as possible, and to divest it of those 
erroneous notions, still entertained by many, which have taken their rise in 
closet speculations rather than from a careful examination of the actual man- 
ner in which the child presents and passes through the pelvis and soft parts 
during labour. The chapter is a highly interesting and instructive one. 



I 



1842.] "Rx^y's System of Midwifery, 129 

Part the fourth is devoted to a consideration of midwifery operations. 
The first chapter treats of the forceps, with the indications for their use, 
and the rules for their application. The second chapter is on the opera- 
tion of turning-, the indications for its employment — the circumstances 
most favourable for its performance, and directions as to the proper manner 
in which it should be effected. Both chapters exhibit the usual character- 
istics of our author as a systematic writer, condensation with great clear- 
ness; while the practical directions detailed in them are sufficiently explicit, 
and throughout highly judicious. 

The Cassarean operation is considered in the third chapter. This is 
one of the few subjects connected with the principles and practice of mid- 
wifery, in relation to which the author has failed to give a satisfactory 
view of the present state of our knowledge. His account of the indica- 
tions for the performance of the operation are certainly any thing but clear 
and precise, and must leave the reader in great doubt as to the value of 
the operation, or the exact circumstances under which its performance is 
warranted. While he would appear inclined to admit of its propriety as a 
means of saving the life of the child as well as that of the mother, he 
nevertheless, deterred probably by its generally unsuccessful termination 
in England, describes the circumstances under which it becomes the duty 
of the surgeon to perform the Caesarean section to be those in which " the 
pelvis is so narrow that the child cannot be brought even piecemeal through 
the natural passage," in which case, even if the child be dead, the opera- 
tion becomes unavoidable. 

The fourth chapter treats of artificial premature labour. This Dr. R. 
considers as " perhaps the greatest improvement in operative midwifery 
since the invention and gradual improvement of the forceps." 

The operation consists in inducing labour artificially, at such a period 
of pregnancy as that the child shall have attained a sufficient degree of de- 
velopment to support its existence afterbirth, and yet be so small, and the 
bones of its head so soft, as to be capable of passing through the con- 
tracted pelvis of its mother. It is resorted to for the purpose of giving 
birth to a living child, under circumstances of pelvic contraction, where 
either the mother must have been exposed to the danger and sufferings of 
the Caesarian operation, or the infant to the certainty of death by perfora- 
tion, or at least where the labour must have been so severe and protracted, 
as to have more or less endangered the lives of both. 

We are happy to find so distinguished an authority as Dr. Rigby, bear- 
ing so decided a testimony in favour of the production of premature labour, 
in those cases in which the delivery of the child at the full period is either 
impossible or attended with imminent danger to both mother and child. 
In his estimateof the practicability and entire safety of the operation, he is 
sustained by some of the most distinguished of the German obstetricians. 

"Professor Kilian, in his work on operative midwifery, has collected the re- 
sults of no less than 161 cases of artificial premature labour; of these, 72 oc- 
curred in England, 79 in Germany, 7 in Italy, and 3 in Holland: of these cases, 
115 children were born alive, and 46 dead: of the 115 living children, 73 con- 
tinued alive and healthy; 8 of the mothers died after the operation; but of these, 
5 were evidently from diseases which had nothing to do with the operation. 

"One great encouragement," Dr. R. remarks, " in cases requiring this operation 
is the fact, that in every successive pregnancy the uterus is more easily excited 
to premature action; and in some cases where it has been induced several times, 
it has at length, as it were, got so completely into the habit of retaining its con» 



130 Reviews, [July 

tents only up to a certain period, that labour has come on spontaneously, exactly 
at the time at which in the former pregnancies it had been artificially induced." 

A very clear account is given in the chapter before us, of the circum- 
stances under which the operation is warranted, the period of pregnancy 
most favourable for its performance, and of the proper manner of perform- 
ing it. 

The next chapter treats of perforation, the cases in which it is indicated, 
and the mode of operating — and concludes with a brief notice of embry- 
ulcia. 

Part \\ie fifth is devoted to a consideration of Dystocia or abnormal par- 
turition — or those labours which either cannot be completed by the natural 
powers destined for that purpose, or at least, not without injury to the 
mother or child. 

Pursuing the arrangement adopted by Professor Naegele, Dr. Rigby 
divides abnormal parturition into two classes. 

" 1. Labours that are difficult or impossible to be completed by the natural 
powers. 

" 2. Labours which are rendered faulty without obstruction to their progress." 

The first may depend upon a faulty condition of the expelling powers, 
or without any anormality in this respect, upon the faulty condition either 
of the child or of the parts through which it has to pass. 

"As it respects the child they may arise from, 1, malposition; 2, faulty form, 
and size of the child; 3, faulty condition of the parts which belong to the child 
on the part of the mother; — 

" From a faulty condition, 4, of the pelvis; 5, of the soft passages; 6, of the 
expelling powers." 

"The second condition where labour is rendered dangerous for the mother or 
her child, without any obstruction to its progress, may arise from — 1. Follow- 
ing too rapid a course. 2. Prolapsus of the umbilical cord. 3. From accidental 
circumstances, which render the labour dangerous, viz. convulsion, syncope, 
dyspnoea, severe and continued vomiting, hemorrhage, &;c." 

In the twelve chapters devoted to a consideration of each of the above 
species of dystocia, will be found, accurately detailed, all the more im- 
portant facts, derived from the experience of the most authoritative writers 
necessary to a correct understanding of the several causes, by which the 
natural course and termination of labour may be impeded or prevented, with 
the means best adapted to prevent, remove, or lessen the difficulty — or to 
effect the delivery of the child without endangering the life of both it and 
its mother. The author's account of abnormal labour, condensed as it 
is, vf\\\ be found perfectly explicit — and marked throughout by a sound 
and discriminating judgment — founded evidently upon a careful study of 
the subject under circumstances peculiarly favourable to the acquisition of 
sound practical views. 

In considering the treatment of that species of dystocia in which the 
propulsive powers of the uterus are defective. Dr. Rigby remarks, that such 
a state of uterine inactivity as will warrant the use of such remedies as 
have the power directly to excite the uterine contractions is extremely 
rare, and he earnestly warns young practitioners against too readily con- 
cluding that it is present. They will find, he remarks, that the more care- 
fully they investigate such cases, the less frequently will they require such 
remedies. In using the secale cornutum, he gives the preference to the 
powder. Borax, according to him, is also another remedy which appears 



I 



1842.J 'Righy^s System of Midwifery. 131 

to possess a peculiar power in exciting the activity of the uterus; although 
it is scarcely ever used for such a purpose in England, its effects upon the 
uterus have been long known in Germany; and in former times, both it 
and the secale cornutum entered largely into the composition of the differ- 
ent nostrums, which were used for the purpose of assisting, labour. Dr. 
R. has combined these two medicines, with, as he states, the best effects; 
he generally gives them in the following manner: — R. Secalis cornuti 9j- 
ij; sodae subborat. gr. x; aq. cinnamomi ^jss. — m. fiat haust. Cinnamon, 
which is a remedy of considerable antiquity, has also a similar action upon 
the uterus, although to a less degree. 

" Our own conviction with regard to the use of these remedies," adds Dr .R., 
*' is, that they are seldom required rfwrm^ labour, except in nates or footling pre- 
sentations, or in cases of turning, where the head is about to enter the pelvis, 
and where, at this critical moment, the action of the uterus is apt to fail, when 
it is important to the safety of the child that there should be brisk pains to force 
the head through the pelvis and internal parts with sufficient rapidity. The 
chief value of these remedies is for the purpose of exciting uterine contraction 
after labour, and thus to promote the safe expulsion of the placenta, where there 
is a disposition to inertia uteri, and insure the patient against hemorrhage. 
Where the contractile power of the uterus is so enfeebled that it becomes nearly 
powerless, we deem it much safer and better to apply extractive force to the 
head by means of the forceps, and thus overcome the natural resistance of the 
soft parts, to using medicines which excite uterine action, and thus stimulate the 
exhausted organs to still farther efforts." 

A very sensible chapter is given on the causes, diagnosis, symptoms and 
treatment of inversion of the uterus. 

In the eleventh chapter of this division of the work. Dr. Rigby treats of 
puerperal convulsions. The description of the different forms of convul- 
sions that occur previous to, during and subsequent to labour are all ably 
described — the facts bearing upon their pathology clearly stated, and the 
remedial measures which experience has shown to be best adapted to their 
prevention and cure accurately detailed. 

Puerperal fevers is the subject of the thirteenth chapter. The author's 
very full and able account of these affections, which are certainly, as he 
truly remarks, the most to be dreaded of any to which a lying-in woman is 
exposed, constitutes unquestionably one of the most interesting and im- 
portant portions of the excellent volume before us. 

After an examination into the nature and varieties of puerperal fever, 
replete with sound pathological views, calculated to lead to more precise 
and correct views in regard to the causes and character of the disease, the 
author proceeds to consider its several forms, under the heads of puerperal 
peritonitis — uterine phlebitis — false peritonitis^and gastro-bilious — and 
contagious or adynamic puerperal fevers. 

"The vitiation of the blood,^^ Dr. Rigby remarks, " has long been a subject which 
has excited our deepest interest, and the admirable researches of Dr. Stevens 
upon the condition of this fluid under the effects of malignant fevers, have 
tended to disclose the real nature of the diseases under consideration. We have 
long been convinced that one of the causes of puerperal fever is the absorption 
of putrid matters, furnished by the coagula and discharges, which are apt to be 
retained in the uterus and passages after parturition, — a view which has been 
adopted by Kirkland, C. White, and other older writers. It is with sincere 
pleasure that we now find ourselves supported by Dr. Ferguson in this opinion." 

"We do not agree with him in supposing that every form of puerperal in- 



132 Reviews, [Ju^y 

flammation is produced by vitiation of the circulating fluids, because in one 
species of uterine phlebitis, which occurred sporadically, and prevailed a good 
deal from 1829 to 1832, it was, in our opinion, evidently produced directly by 
the absorption of putrid matter into the uterine veins and lymphatics, exciting 
inflammation in these vessels; the same cause, when only carried to a certain ex- 
tent, produces a local inflammation, which, when affecting the general circula- 
tion, is followed by fever — the local and constitutional disturbance arising from 
the same cause, imbibition or absorption of putrid matter, the one being the 
local, the other the general effect, but not the one resulting from the other. The 
doctrine of the vitiation of the blood from its admixture with pus secreted by 
the lining membrane of an inflamed vein, though very plausible, still requires 
further confirmation, for it is doubtful if the introduction of pure healthy pus 
into the circulation produces any of those dangerous effects whicli result from 
the introduction of putrid matters, whether purulent, sanious, mucous, &c. It is 
the introduction of an animal poison generated by putrefaction, which destroys 
the vitality of the blood, and renders it unfit for maintaining the vital powers." 

Dr. Rigby does not, however, refer the cause of puerperal fever solely 
to the absorption of putrid matters by the uterine veins and lymphatics, 
but to the still more pervading and truly epidemic, and contagious action 
of the miasmata, with which the air that surrounds the patient is charged. 
The lungs, he remarks, afford a ready and ample means by which efifliuvia 
may be conveyed into the circulating current. 

Under the inflammatory form of puerperal fever. Dr. R. considers as 
well that form of acute peritonitis, so ably described by Dr. Locock, which 
is chiefly produced by the efl^'ects of labour, and in the treatment of which 
the lancet and other antiphlogistic remedies are demanded to a greater or 
less extent, but also that form which, according to Dr. Ferguson, arises 
from vitiation of the blood, by the introduction of putrid matter into the 
circulation, commencing with the symptoms of uterine phlebitis, but ter- 
minating invariably, if not stopped at an early period, in peritonitis — a 
form of the disease which, according to our author, has not only a great 
disposition to assume a typhoid character, but also to become epidemic. 

In this form of the disease Dr. R. directs great caution in the use of the 
lancet and other depletory remedies. He has become more than ever con- 
vinced, from the results of his own experience and other considerations, 
that it is not a remedy which is alivays to be premised before the em- 
ployment of other remedies, as in cases of simple inflammation of the 
viscera or serous membranes. 

" The only circumstances we apprehend," he adds, " under which venesection 
ought to be employed in this form of the disease, are where the pain is constant, 
without intermission, and where, besides its rapidity, the pulse betrays a degree 
of wiry resistance to the finger, which can never be mistaken. In this case the 
blood drawn will show all the usual marks of inflammation, and the relief pro- 
cured will be proporiionably great." 

The doctor directs, in cases of uterine phlebitis, the patient to be placed 
in such a posture, as to favour the escape of any coagula and discharges, 
which may have been stagnating in the uterus or vagina; to effect which 
more completely, a stream of warm water should be thrown up briskly into 
the uterus. To increase the action of all the excretory functions, and thus, 
as far as possible, remove the virus, which may have already entered the 
system. Dr. R. conceives that the administration of calomel in doses of ten 
grains, combined with James's or antimonial powder, is one of the most 
eflfective means we possess. When there has occurred evident abatement 



1842.] Righy^s System of Midwifery, 133 

or remission of pain, he directs the calomel to be combined with an equal 
quantity of Dover's powder in the form of pills; the calomel to be followed 
in a few hours, or if given over night, in the morning, by a solution of sul- 
phate and carbonate of magnesia. To relieve pain, and promote perspira- 
tion, hot lintseed meal poultices are directed to the abdomen — to be con- 
tinued until the pain has entirely ceased; the vagina being well syringed 
with warm water, from time to time as occasion requires. 

In the sections which treat of gastro-bilious and the contagious or 
adynamic forms of puerperal fever, will be found a very excellent digest 
of the present state of our knowledge in relation to their diagnostic phe- 
nomena, pathology and treatment. 

The propriety of direct depletion in this latter form of the disease has 
been a question of much dispute among physicians, some insisting upon 
its early and full employment as essential to the successful treatment of at 
least the majority of cases, while others proscribe it entirely as not only 
useless, but decidedly prejudicial. Upon this important point of practice 
the author makes the following judicious remarks: 

" There is no doubt that, wherever the state of the patient will permit it, the 
lancet should be tried. Where the pulse is quick and small with little power, it 
is scarcely more than an experiment to ascertain how the system will bear the 
bleeding: in the worst cases of the adynamic form, uncomplicated by the slight- 
est effort at reaction, the state of collapse at once forbids such an attempt: but in 
many instances the circulation is merely oppressed, the pulse rises in volume as 
the depletion proceeds; and where from its feel before the operation we had little 
hopes of taking away more than five or six ounces, we are often enabled to con- 
tinue it until a considerable quantity is lost. In other cases frightful exhaustion 
is the immediate effect, and warn us instantly to discontinue it. The capability 
of bearing bleeding may be always looked upon as a favourable prognostic, not 
only because the patient's strength is better than we had perhaps expected, but 
also because these are precisely the cases where mercury can be used with de- 
cided benefit; whether it be the bleeding, which in all probability renders the 
system more easily brought under the influence of this medicine, we will not 
stop to consider; at any rate, its effects are not only more easily obtained, but 
they exert a more decided control over the progress of the disease; the pain 
abates, the tympanitic abdomen becomes less tense, the pulse slower, fuller, and 
softer, the tongue moister, and there is a sense of general improvement in the 
patient's feelings. But in the adynamic form, when present in its greatest in- 
tensity, either there is not sufficient time to impregnate the system, or it is less 
sensible to its effects: at any rate, even if we succeed in producing salivation, 
little or no improvement follows." 

Phlegmasia Dolens is the subject of the fourteenth chapter. This affec- 
tion Dr. Rigby attributes to inflammation and obstruction of the main lym- 
phatic trunks leading to the aflected limb. He denies that it is invariably 
dependent upon inflammation of the iliac and femoral veins as maintained by 
Dr. Lee, and even when phlebitis of these vessels is present, he considers 
that the production of the disease is to be accounted for by the inflammation 
spreading to the surrounding fascia or cellular tissue through which the 
larger lymphatics of the thigh pass in their way to the abdominal cavity. 

The causes of the disease Dr. R. considers as of precisely the same 
character as those of uterine phlebitis; the absorption or imbibition, namely, 
of putrid matter from the cavity of the uterus. 

'I'he treatment recommended is, to apply leeches to the seat of the pain 
and tension, followed by cold evaporating washes, or even the application of 
ice over the femoral ring. Internally, calomel is to be administered to such 
No. VII.— July, 1842. ' 12 



134 Reviews, [July 

an extent as to affect the system, and when the local pain has ceased, a 
plaster of camphorated mercurial ointment over the affected part; when the 
acute stage of the disease is past, quinine with gentle frictions of the affect- 
ed limb v/ith the compound camphor liniment. 

An account of puerperal mania; the different forms under which it 
occurs, its causes, symptoms and treatment, closes the volume. 

Our very favourable estimate of the value of the present system of mid- 
wifery will have been perceived by the remarks already made; we can 
with great confidence recommend it to the younger members especially of 
the profession, as a work they will feel inclined frequently to consult. As 
a text book for the use of the student of the obstetric art we know of none 
superior, 

D. F. C. 



1842.] 135 



BIBLIOGRAPHICAL NOTICES. 



Art. XIII. — Lectures on the Diagnosis^ Pathology and Treatment of the Diseases 
of the Chest. — By W. W. Gerhard, M. D., Lecturer on Clinical Medicine to the 
University of Pennsylvania, &c. &c. Philadelphia: Haswell & Barrington, 
1842, 8vo. 

These lectures of Dr. Gerhard, originally published in the Medical Examiner 
during the years 1840-1, have been collected by the author in a separate volume, 
with such alterations and corrections as this change seemed to indicate. In 
their present form, therefore, the)'^ may be regarded as a well digested summary 
of the author's opinions on a very important and interesting class of diseases. 
An attentive perusal cannot fail, we think, to convince every one that they con- 
tain not only the evidences of an extensive acquaintance with the best received 
opinions on these diseases, but the results of much personal observation. Those 
parts of the work which strike us most favourably are, that portion devoted to 
the pathology of thoracic diseases, to which we conceive it would be very diffi- 
cult to add anything of importance, and that devoted to the general exposition 
of the physical signs. Dr. G. has devoted a large space to the latter subject, 
and, as we think, has established its just importance and value in the diagnosis 
of thoracic disease, and in the most satisfactory manner. 

We make these general remarks on the work before us without intending to 
enter into a particular analysis of its merits. Indeed it would be impossible to 
do this in relation to a work embracing such a variety of topics, without going 
very far beyond the limits of a bibliographical notice. Having then expressed 
our very favourable opinion of the work as a whole, and wishing to recommend 
it to the careful study of those interested in the subjects of which it treats, we 
will simply allude to a few points which do not strike us quite so favourably. 

Although the general style of these lectures is simple, unpretending, and we 
may add clear, yet there is sometimes a want of distinctness in placing great 
and leading principles and facts before the reader which is certainly objection- 
able. We are well aware that in a lecture this can be best done by the manner of 
delivery, but in a published lecture, especially, when revised expressly for pub- 
lication, the want of this should have been supplied by increased force of expres- 
sion and a change in the arrangement of certain parts. If we examine particular 
portions of the work we shall see this defect extremely conspicuous. Take for 
instance the lecture on the valvular diseases of the heart. We question very 
much whether the inexperienced student would derive any very clear or satisfac- 
tory ideas from its perusal. Indeed the whole of this part of the subject (the 
diseases of the heart) appears to us to be treated in a much less satisfactory 
manner, if we except pericarditis, than that relating to the lungs. For ourselves 
we are inclined to believe that the diagnosis of these cardiac affections is far 
more advanced and certain than Dr. Gerhard would lead us to believe. 

J. A. S. 



136 Bibliographical Notices, [Ju^y 



Art. XIV. 1. Second Annual Report of the Directors of the Marine Insane HoS' 
pital. December^ 1841. Augusta, Me., 1841, pp. 56. 

2. Ninth Annual Report of the Trustees of the State Lunatic Hospital, at Worcester , 
{Mass.) December, 1841. Boston, 1842, pp. 102. 

3. State of the New York Hospital and Bloomingdale Asylum, for the year 1841. 
New York, 1842, pp. 132. 

4. Twenty-ffth Annual Report on the State of the " Asylum for the Relief of Per' 
sons deprived of the use of their Reason^ Philadelphia, 1842, pp. 30. 

5. Third Annual Report of the Directors and Superintendent of the Ohio Lunatic 
Asylum, to the Fortieth General Assembly. Columbus, (Ohio,) 1841, pp. 60. 

6. Annual Report of the Court of Directors of the Western Lunatic Asylum, to the 
Legislature of Virginia; with the Report of the Physician, for 1841. Richmond, 
Va., 1842, pp. 80. 

7. Report of the Superintendent of the Eastern Lunatic Asylum, Williamsburg, 
Virginia, from July 1st, 1841, to December 3\st, 1841. 

8. Extracts from a Lecture on Insanity; delivered before the Young Men'^s Associa- 
tion (fthc city of Utica. February ].8th, 1842. By C. B. Coventry, M. D. 

9. What shall we do with the Insane of the Western Country? By Edward Jarvis, 
M. D. 

1 0. Fifth Annual Report of the Trustees of the Vermont Asylum for the Insane,^ 
October 25th, 1841. 

1 1. Report of the Trustees of the State Lunatic Asylum, with the documents accom^ 
panying the same, to the Legislature of the State of New York. pp. 203. 

As faithful chroniclers of the progress of our profession in all its departments, 
our duty leads us to record the current medical history of the public insti- 
tutions for the insane, while our admiration for a noble philanthropy renders that 
duty a pleasure. In regard to the rapid, efficient, practical improvement in the 
means for the comfortable accommodation and judicious treatment of those 
afflicted with mental alienation, the annals of the world can probably furnish no 
parallel to the United States. The actual progress in the establishment of 
lunatic asylums in this country, is thus noticed in the Sixteenth Annual Report 
of the Prison Discipline Society. — "It appears that one institution was estab- 
lished, and another used for the insane, in the eighteenth century. Two were 
established in the first twenty years of the nineteenth century; three from 1820 
to 1830; eight from 1830 to 1840; and six are opened, provided for, or being 
built in 1840 and 1841, besides much preparation for three others." The last 
annual reports of several of these institutions being now before us, we proceed 
to collect therefrom the most important and valuable facts. 

1, During the past year, the number of admissions into the Maine Insane 
Hospital was 105, of which 62 were of men, and 43 of women. Discharged in 
the same time, 79. Of the 105 admissions, 45 were of less duration than one 
year, and 60 were of longer standing. Of the 79 discharged, 38 were recent 
cases, of which 27 recovered, and 3 died; and 41 were chronic, of which 6 re- 
covered, and 3 died. Per centage of deaths on the whole number in the hospital, 
4.5. The elaborate report of Dr. Ray, the superintending physician, is chiefly 
devoted to an exposition of the object of asylums for the insane, their paramount 
utility in the treatment of mental disorders, and the great importance of resorting 
to them in the early stages of the disease. This is intended particularly for the 
people of Maine, in order, by giving them accurate ideas of the disease and of 
its appropriate remedies, to induce them to avail themselves of the benefits of 
the institution more generally than has hitherto been done. The sentiments 
contained in one portion of this report are so frequently met with in the similar 
publications of other asylums, and their importance being such as to require a 
wide dissemination, we extract the paragraph entire. "Above all things, in 
order to obtain the confidence of our patients, we find it necessary to abstain 
from every kind of deception in our dealings with them. Nothing irritates an 



I 



1842.] Reports of Insane Hospitals. 137 

insane person, or paralyses the efforts of others to help him, more than decep- 
tion, which, with his strong disposition to suspicion, inevitably makes an unfa- 
vourable impression upon his mind. Whenever he discovers it, and sooner or 
later he will, he regards the author of it as one of his enemies, who are banded 
together to deceive, tease and harass him. If people were generally aware of 
this trait in the insane, they would be more cautious how they endeavour to 
obtain the smallest point by any other than honest and straightforward means. 
Scarcely a patient is brought to us who has been correctly informed respecting 
the nature of the place he is going to, or how long he is to remain. The conse- 
quence is, when he discovers the deception, that he imbibes an aversion towards 
his friends that may not very easily be overcome, and looks upon us as parties 
to the wrong that has been done him. Thus, at the very outset, we are met by 
a serious difficulty which it may require weeks or months for us to remove." 

2. The Ninth Report of the Massachusetts State Lunatic Hospital, like all 
which have emanated from the pen of Dr. Woodward, is fraught with subjects 
of deep interest to the physician, the philanthropist, and all who regard the wel- 
fare of suffering humanity. During the past year, 73 men and 90 women, a 
total of 163 patients, have been received into this hospital. These, with the 
236 remaining at the commencement of the year, make 399 who have enjoyed 
the benefits of the institution during that period. Discharged or died, men 77, 
women 90. Of the former, 38 were restored, and 7 died; of the latter, 44 were 
restored, and 5 died. Of the admissions, 84 were recent cases, and 79 chronic. 
Of the discharges, 68 were recent cases, of which 62 were restored, and 4 died; 
and 99 were chronic, of which 20 were restored, and 8 died. At the close of 
the year, there remained in the hospital 116 men, and 116 women; total, 232. 
The daily average number of patients, for the year, was 233. The report states 
that the hospital is always full, and during the past year, 91 applications have 
been rejected for want of room. 

During the nine years that the hospital has been in operation, 1359 patients 
have been admitted, of whom 710 were men, and 649 women. Single, 715; 
married, 508; widows, 88; widowers, 48. The whole number of recoveries was 
588; of deaths, 102. According to Dr. Woodward's observations, "spring 
affords the greatest number of cases, autumn the greatest number of recoveries, 
and summer the greatest number of deaths." 

We extract the following paragraph, because its testimony goes to controvert 
a generally received opinion in regard to the age at which insanity is the most 
susceptible of cure. 

"It still continues to be an interesting fact, deducible from our records, that 
persons attacked with insanity after 40 years of age, recover in much greater 
proportion than those attacked before that age." 

The number of patients in each decennium of life, admitted during the nine 
years, was as follows: — Under 20 years of age, 79; between twenty and thirty, 
356; thirty and forty, 383; forty and fifty, 275; fifty and sixty, 144; sixty and 
seventy, 88; seventy and eighty, 35; over eighty, 1. 

Of 99 patients who have died, (the proper data whereon to base the calcula- 
tion, not being attainable in the remaining 6,) the average age at the commence- 
ment of the disease was, in men, 41 years, 6 months; in women, 42 years, 3 
months; mean, 41 years, 10 months, 15 days. The average duration of life after 
the individuals became insane, was, in men, 6 years, 5 months, 19 days; in 
women, 3 years, 3 months, 12 days; mean, 4 years, 4 months, ISi days. The 
average age at which the 99 died was, in men, 47 years, 2 months; in women, 
45 years, 6 months, 12 days; mean, 46 years, 4 months, 6 days. 

In a large number of paroxysmal cases, the commencement of the paroxysms 
have been observed in reference to the several phases of the moon. After hav- 
ing stated the results of these observations. Dr. Woodward says: — "These 
facts and coincidences we leave for the present, with the single remark, that no 
theory seems to be supported by them, which has existed either among the igno- 
rant or the wise men who have been believers in the influence of the moon upon 
tlie insane." 

12* 



138 Bibliographical Notices. [July 

An impression prevails to some extent in the community, and particularly 
among the members of the medical profession, that the superintendent of the 
hospital at Worcester professes to effect a restoration of the insane, in a far 
greater proportion of the cases under treatment, than has heretofore been the 
result in other institutions of the kind. This impression we believe to be erro- 
neous. It certainly is not sustained by the facts embodied in his reports. We 
quote his own language from the report before us. "The average of recoveries 
of cases of less duration than one year, is now 88 per cent, for the whole time, 
and is as great as can ever be expected. The per cent, of all the recovered on all 
the admissions in this hospital, is r\ovf forty -three and one-third,, and the per cent, 
of discharges recovered, on the admissions this year, is fifty and one-third." 
The proportion (88 per cent.) of recent cases, above-mentioned, is upon the dis- 
charges. In another place, he states that the proportion of cures of recent cases 
on the whole number of admissions is 83.75 per cent., and of chronic cases 
20.33 per cent. Setting aside the distinction between recent and chronic cases, 
and adopting the only unambiguous basis of comparison, that of the proportion 
of cur(;s on the whole number of admissions, we proceed to notice the results in 
some of the British institutions. At the Retreat, near York, Eng., the cures 
during forty-four years, ending in 1840, were equivalent to 47.31 per cent.; at 
the Exeter Asylum, from 1801 to 1840, 52.43 per cent.; at Bethlehem Hospital, 
London, from 1829 to 1840, 50.96 per cent.; at the Gloucestershire Asylum, 
from 1823 to 1832, 44.94 per cent.; at the Asylum at Wakefield, from 1818 to 
1841, 44.18 per cent.; at the Asylum of Aberdeen, Scotland, from 1830 to 1840, 
45.12 per cent.; and at the Armagh Asylum, Ireland, from 1825 to 1840, 45.27 
per cent. In all of these, as well as in several other British institutions, the 
proportion of cures exceeds that at Worcester; while, on the contrary, at the asy- 
lums of Kent, Lancaster, Hanv/ell, Nottingham, St. Luke's of London, Lincoln, 
Dundee, Montrose, Connaught, Waterford, and some others, the similar propor- 
tion is less than that at Worcester. The average per cenlage of cures in eleven 
Irish asylums, is stated at 45.91, which exceeds by k58 that at Worcester. 
While we are fully sensible that an accurate, detailed comparison of the results 
of different asylums can be effected in no way other than by a consideration of 
numerous circumstances and conditions in the nature, organization and rules of 
the institutions themselves, yet we believe that the comparison here instituted 
does not sufficiently involve those conditions to prevent an approximation, at 
least, towards the truth. It has been made with no other motive than that sug- 
gested above — to correct an erroneous impression. While we have shown that 
the results of several institutions have been more favourable than those at Wor- 
cester, we are firmly convinced that all other conditions and influences being 
equal, the asylum under the care of Dr. W. would present as large a proportion 
of cures as any other. 

3. Although foreign to the special object of this notice, yet as conveying 
important information, we quote the following synopsis of the results of treat- 
ment in the New York Hospital. "The number of patients in the Hospital on 
the 31st of December, 1840, was 187; and there were admitted during the year 
1841, 2000; making a total of 2187 persons who have received the benefits of 
the institution in the course of the year. Of this number, there have been cured 
1501; relieved, 84; discharged on their own request, 163; discharged as impro- 
per subjects, 26; eloped or discharged as disorderly, 40; died, 193; remaining, 
180." 

By the comparatively brief, but well written report of Dr. Wilson, of the 
Bloomingdale Asylum, a detached department of the New York Hospital, it 
appears that the number of patients in that institution, at the commencement of 
the year, was 131; admitted during the year, 102; total, 233. Discharged or 
died during the same period, 100; remaining at the close of the year, 133. Of 
the 102 admissions, 71 were of recent, and 31 of chronic cases. Of the dis- 
charges, 58 were recent, of which 46 were cured, and 5 died; 42 were chronic, 
of which 9 were cured, and 13 died. "The number of deaths during the year," 
says the report, " has been unusually large; not the consequence of any epide- 



1842.] Reports of Insane Hospitals, 139 

mic, but rather of the accumulation of old cases, and the necessary progress and 
termination of extensive organic disease." This asylum "rejects no application 
for admission, whatever the state or condition of the patient, curable or incura- 
ble, in ordinary physical health, or in articulo mortis.'''* 

The following tabular extract exhibits the most important result of treatment, 
from 1823 to 1841 inclusive:— 

Admitted. Recovered. Per cent. 

Chronic cases, 1037 120 11.5 

, Recent " 1336 1020 76.33 

The following table is more elaborate, and includes a greater number of cases, 
being all those admitted from 1821 to 1841 inclusive. 

Men. Women. Total. Died. 

Admitted, 1692 906 2598 240 

Recovered, 848 352 1200 



Percent. 50.12 38.84 46.20 9.25 

4. The number of patients at the Frankford Asylum, at the commencement 
of the year, was 58; admitted during the year, 39; discharged, 36; died, 3; re- 
maining at the end of the year, 58. Of the 36 discharged, there were restored, 
13; much improved, 4; improved, iO; stationary, 9. Five of those discharged, 
unrestored, were apparently curable, and would probably have recovered had 
they remained a sufficient length of time under of treatment. The proportion of 
chronic and incurable cases, among those admitted, was unusually large. Dur- 
ing the twenty-five years that this asylum has been in operation, the number of 
admissions has been 784. Of these, 149 were re-admissions of96 individuals, leav- 
ing but 635jOfrsons received as patients. Of these 635, 263 were restored, 65 much 
improved, and 87 died. " Of the 96 patients re-admitted, there were discharged 
restored, 49; much improved, 4; improved, 10; stationary, 9; died, 17; remain- 
ing, 7. Twenty-eight were admitted a third time; of whom there were dis- 
charged, restored, 16; improved, 3; stationary, 5; died, 2; remaining, 2. Eight 
were admitted a fourth time, of whom 6 were restored, 1 much improved, and 
1 died. Two returned a fifth time, of whom one is stationary, and the other 
recovering; one, a sixth time, and was discharged, recovered; and two ten 
times each, of whom one died, and the other recovered." 

5. In the Ohio Lunatic Asylum, there were, at the commencement of the year, 
138 patients, 73 men and 65 women. Admitted during the year, 85; discharged, 
81; remaining at the end of the year, 142. Average number during the year, 
143. Of those discharged, there were 44 recovered, 5 improved, 18 incurable; 
and 14 died. 

During the three years since this asylum was opened, 186 men and 157 wo- 
men, a total of 343 patients, have been received. In the same period, 201 have 
been discharged, of whom there were recovered, 124; improved, II; incurable, 
28; idiotic, 2; died, 36. Of the 343 admitted, 171 were single, 135 married, 
26 widows, and 11 widowers. Arranged according to their ages at the time of 
admission, they are as follows: — Under 20 years, 13; between twenty and thirty, 
137; thirty and forty, 91; forty and fifty, 61; fifty and sixty, 34; sixty and 
seventy, 6; over seventy, 1. Since going into operation, this asylum has re- 
ceived two hundred and eight applications for admission, which were necessarily 
refused for want of room, or because the patient was a non-resident of the state. 

In the able and interesting report before us. Dr. Awl urges the importance of 
extending the accommodations of the asylum, so as more nearly to supply the 
wants of the community; — exhibits, by contrasting the expenses of chronic and of 
acute cases, the pecuniary advantage of early treatment; reports several interest- 
ing cases which have been under his care, and makes some valuable remarks 
upon the causes of insanity, the value of labour and of religious services in its 
treatment, and upon other topics connected with the general subject. 

6. By the ample report of Dr. Stribling, it appears that the VV^estern Lunatic 



140 Bibliographical Notices, U^^Y 

Asylum, of Virginia, is in a very prosperous condition. During the past year, 
an additional edifice, for the accommodation of sixty patients, has been erected. 
The necessity of this is demonstrated by the fact, that there have been 180 appli- 
cants for that department alone. The asylum can now accommodate 100 men 
and 41 women. The number of patients at the beginning of the year, was 69; 
admitted daring the year, 53; total, 123. Discharged recovered, 15; eloped, 1; 
died, 6; remaining, 100. Two had recovered who had still remained in the 
asylum. " Our list of discharges," says Dr. S., " must be restricted almost ex- 
clusively to those who may recover, elope or die. By far the greater number 
of our patients are paupers, who were brought here in the chronic stage of insa- 
nity; and we are compelled by law, to keep them during life, or until cured." 

From July 1, 1836, to November 1, 1841, the number of admissions was 131; 
of cures, 51; and of deaths, 21. From 1828 to 1841, inclusive, the average 
annual number of patients was 60; that of deaths, 3; mean per centum of deaths, 
5. The report under notice contains an account of the present condition of many 
of the lunatics of Virginia, who have never enjoyed the benefits of a public in- 
stitution. In this, the same fearful picture of misery and suffering, of imprison- 
ment, manacles and chains, which has heretofore been depicted in other states, 
is again brought before the view, in all its hideous deformity. 

7. Heretofore, it has not been customary for the officers of the Eastern Luna- 
tie Asylum, at Staunton, Virginia, to publish an annual report, and the one now 
before us we suppose to be the first of a prospective series. We trust that, here- 
after, the octavo or large duodecimo form will be adopted in preference to the 
quarto, that in which this is printed. Aside from the greater convenience to the 
reader, those smaller forms are generally adopted by other institutions, and, by 
establishing a uniformity in this respect, those who preserve these pamphlets are 
enabled to have them bound up together. On the 1st of July, 1841, Dr. Joha 
M. Gait assumed the duties of superintendent of this asylum. At that time it 
contained 109 patients, of whom 68 were men, and 41 women. A large majority 
of them were incurable. From the 1st of July to the 31st of December, of the 
same year, 14 were admitted, 11 discharged, and 15 died. Of the 11 discharged, 
9 were cured, and one so far improved as to recover in a short time afterwards. 
In this report, Dr. Gait recommends several judicious innovations, and evident 
improvements in the organization and discipline of the asylum. It is with plea- 
sure that we perceive this institution adopting the modern improvements, and 
commencing that intercourse with the community and with other asylums, which 
can be effected through the medium of reports alone. 

8. The annual reports of the public institutions of the United States, have 
acted as powerful instruments in awakening public sentiment in favour of the 
Insane. This increasing interest has entered the ranks of the Medical profes- 
sion, and is manifested by the greater attention devoted by writers, to the sub- 
ject. We have two pamphlets which have recently appeared, that of Dr. 
Coventry, and that of Dr. Jarvis. Dr. Coventry, in his lecture before the 
Young Men's Association of Utica, does not, we presume, profess to throw 
any new light upon the subject, but rather, by condensing into the narrow com- 
pass of a lecture, as great an amount as possible, of truths with which we are 
already familiar, to illuminate minds hitherto unenlightened in regard to the dis- 
ease. He treats upon the causes, symptoms, pathology and treatment of insa- 
nity, the location, construction and organization of asylums, and subsequently, 
gives the statistics of the disease in the state of New York, followed by a his- 
tory of the asylum at Utica. According to his exposition, even after the pre- 
sent building, which will accommodate from 250 to 300, shall be filled, there will 
be 1555 lunatics and idiots in the state, unprovided for by the public institu- 
tions. 

The prevailing doctrine of the pathology of the disease is given in the lan- 
guage of Dr. Bottex. In this generally valuable lecture of Dr. C, there are, 
in a few instances, assertions of a somewhat too sweeping or exclusive a cha- 
racter. Of this kind is the following: "./?// the modern writers on insanity 
consider it a disease of the brain; at first functional, but, if it permitted to go on, 



1842.] Beports of Insane Hospitals. 141 

producing changes in the organization of this organ, in which state the disease 
is generally incurable." From this assertion we must except Leuret and some 
of the German authors. Without assuming the prerogative of philological cri- 
ticism, we may venture to express a doubt whether the following sentence con- 
veys the idea intended by the writer. " In the McLean Asylum, patients fre- 
quently have an attendant^ whose whole attention is devoted to himself ^ There are 
many attendants who would rejoice in a possession of a situation of that kind! 

9. A few months since. Dr. Edward Jarvis, of Louisville, Kentucky, publish- 
ed an essay on insanity, and Insane Asylums, of which a bibliographical notice 
appeared in the last number of this Journal. More recently, the author has 
published a pamphlet entitled, " What shall we do with the Insane of the 
Western country." The object of this, as may be inferred from the title, is to 
awaken the attention of our Western neighbours, and bring them to a decision 
upon "what shall be done with the four thousand four hundred and forty-one 
lunatics and idiots that live in the valleys of the Ohio and the Mississippi." In 
pursuance of this object, Dr. J. examined the condition of those insane and 
idiots in reference to their curability. He then demonstrates the utility of re- 
moving them from their houses, supporting the proposition by quotations from 
several authors. Having discussed the merits of confinement in prisons, of 
travel, and of boarding in private families, and shown the first to be " worse 
than useless," and the last two to be ineffective in a great majority of cases, he 
arrives at the conclusion that " the Hospital" is the most appropriate resort, and 
furnishes the most effective means for treatment. The progress of asylums for 
the insane is traced, and, in connection with the question, how far the existing 
institutions can be available for the lunatics of the West, most of those institu- 
tions are described. From this description we extract the following, inasmuch 
as it will explain the unsatisfactory results of treatment in the asylum of which 
it speaks. 

" The Kentucky Lunatic Asylum was established before the late discoveries 
had shown how far this disease is controllable by attention, skill, and most faith- 
ful and tender watchfulness, in conjunction with variety of occupation. The 
original plan did not include a physician exclusively devoted to the institution; 
nor workshops, nor riding, nor reading, nor a great variety of attendants. Nor 
was labour at first designed as one of the great means of improvement. A chap- 
lain and religious worship were not then considered necessary for such an insti- 
tution. A physician is engaged to visit the asylum once a day; but his pay for 
this is so small that he cannot neglect his general practice to spend much time 
among the lunatics. A few attendants are employed, rather to guard and wait 
upon the patients, than to be their companions, to guide their thoughts and con- 
trol their feelings. Since the establishment of this asylum, the state has not 
altered the original plan, nor provided officers, attendants and means according 
to the spirit of this improved age. But an effort is now making in the legisla- 
ture to obtain such farther grants and privileges from the state, as will place this 
institution on as good a foundation as the best in the United States." 

In a note appended to the essay, the author remarks, " We are informed that 
there is no doubt that the legislature will grant to this asylum all the facilities 
that its warmest friends desire — a well-paid physician, a sufficient corps of atten- 
dants, and lands and shops for the occupation of the patients." 

After this review of asylums. Dr. J. proceeds: "From this examination, we 
are led to the melancholy confession of the w^ant of due provision for the com- 
fort and the cure of the insane sufferers of the western country. In this broad 
and rich valley, from the Lakes to the Gulf of Mexico—from the Alleghanies to 
the Rocky Mountains, embracing a sane population of five millions, and lunatic 
population of more than four thousand, with no deficiency of wealth, skill, or 
benevolence, we have but four asylums for the insane. And these could not 
contain a tithe of all who might be subjected to their influence, and not a fourth 
of those who could be benefited by them. We ought to have public asylums 
in Indiana, Illinois, Missouri, Arkansas and Mississippi. And, besides these, 
we want another asylum in the West, one of more elegant accommodations than 



142 Bibliographical Notices. [J"ly 

ought to be expected in any state institution; — a hospital to be planned and con- 
structed, furnished and administered, according to the best ideas of the present 
age." 

The author describes what this asylum should be in its construction and or- 
ganization, giving the opinions of various authors in regard to the most suitable 
plans for buildings of the kind. This vi^ell written essay of Dr. Jarvis, in con- 
nection with the preceding one by the same author, both exhibiting profundity of 
research and extensive reflection upon the subjects discussed, is admirably calcu- 
lated to effect the benevolent object which stimulated the writer to its composi- 
tion. 

10. By the following extract from the report of Dr. Rockwell, it will appear 
that the Vermont State Asylum has been enlarged. " We rejoice in the en- 
largement of our building the past season. We have suffered for the want of 
sufficient accommodations. Our prospects are now fair that we shall be able 
to receive all who may apply for admission." 

The number of patients in this asylum at the beginning of the year was 81. 
Admitted during the year, 84; discharged, 70; remaining at the end of the year, 
95. Of the 70 discharged, 35 M^ere recent cases, of which 31 recovered, and 1 
died; and 35 were chronic, of which 10 recovered, and 3 died. During the five 
years that the asylum has been in operation, 323 patients have been admitted, 
and 228 discharged. The whole number of recoveries is 138, and of deaths, 15. 

1 1 . New York, an Amazon among the sister states in regard to extent and popu- 
lation, proved herself, years since, to be equally majestic in regard to internal 
improvements, and still preserves the characteristic in her noble efforts for the 
relief of her suffering insane. The State Pauper Lunatic Asylum at Utica, pro- 
jected a few years since, and its front building now nearly finished, will accom- 
modate, when completed, one thousand patients. No British Asylum is calcula- 
ted for so great a number; the largest, that of Hanwell, having rooms for about 
nine hundred; and of the continental institutions, Salpetriere alone, unless, per- 
haps, we may include Bicetre, is equally commodious. 

In May, 1841, the legislature of New York authorized the appointment of a 
Board of Trustees, a subordinate committee of which should be required to visit 
asylums for the insane in New York and other states, " inquire into their go- 
vernment, organization and internal arrangements, and submit to the legislature 
a system for the government, discipline and management of the State Lunatic 
Asylum." The Report of the committee appointed in pursuance of this act, is 
now before us — the giant of its genus, as is the institution to which it relates. 
With its appended documents, it forms an octavo volume of 233 pages. The 
committee give a succinct sketch of the history of insanity, and an outline of 
the modern mode of treatment; discuss the question of what classes of patients 
should be received into the asylum at Utica, and some other topics in connection 
with the subject. After speaking of the important duties devolving upon the 
superintendent of such an institution, they proceed as follows: 

*' Where is the individual whose high and varied qualifications, moral, intel- 
lectual and physical, in rare but indispensable combination, fit him for such mul- 
tifarious duties? To whom is such a sacred and momentous trust to be confided'? 
To an active, charitable, conscientious man of good sense and mild manners, 
with perfect self-command and a thorough knowledge of human nature: — to a 
well-educated physician, of tact, firmness and experience, familiar with the im- 
proved medical and moral treatment of insanity; to an energetic philanthropist, 
of calmness and decision, of moral and physical courage, who is never weary of 
doing good, whose benevolence can make the lunatic a companion and friend, in 
all the essential qualities of reciprocal confidence, mutual forbearance, fellow- 
feeling and rational counsel, and whose refined sense of duty 'guides even 
kindness and affection in their ministrations, and holds the balance as scrupu- 
lously in deciding on the moral rights of the insane, as on the civil rights of 
other citizens.' That such a person can be found, the trustees confidently be- 
' lieve." 

Whether Dr. Woodward, of the Massachusetts State Lunatic Hospital, 



1842.] Pharmacopoeia of the United States. 143 

was before the " mind's eye" of the writer of this extract, we do not know, but 
we more than half suspect it to have been the case, as well from the likeness of 
the picture as from the fact that the gentleman in question has received the ap- 
pointment to the place referred to. 

The report contains a system of rules and regulations for the asylum at 
Utica — a table of the insane of the United States, according to the late census — 
similar tables of the insane of the State of New York, by counties, according 
to both the national and the state census — a statement of the number of lunatic 
paupers confined in jails, &c., at public expense, throughout the state — a speci- 
fication of the plan of the asylum and estimates of the expense of furniture. 
Among the appended documents are, a description of the insane asylums in 
actual operation in the United States — letters from the superintendents of most 
of those asylums, giving much general and specific information in regard to 
them — extracts from the published reports of asylums, from "a visit to thirteen 
asylums, in Europe," and from the report of the commissioners of the Massa- 
chusetts State Lunatic Hospital — a sketch of the labours of Pinel, and an article 
from the Report of the Prison Discipline Society, illustrative of " important 
principles adopted by the superintendents of insane asylums in the treat- 
ment of the insane." Such is a synopsis of the contents of the publication 
before us. Under these several heads is found a large portion of actual know- 
ledge of the most judicious discipline and government of hospitals for the in- 
sane, the proper method of treatment, and several other kindred or collateral 
subjects. It is to be hoped that this report will be widely circulated in the 
Utiited States, since, should it fall into judicious hands, it would act as a power- 
ful stimulus to energetic measures in behalf of lunatics in those states which, 
hitherto, have taken no steps towards the melioration of the condition of that 
unfortunate class. It may serve, also, as a guide to future commissioners or 
boards of trustees, rendering their labours comparatively trifling, by present 
ing to them, already collected, digested and condensed, a vast amount of factg 
necessary to a faithful fulfilment of their duty, 

P. E. 



Art. XV. — The Pharmacopoeia of the United States of America^ hy authority of 
the National Medical Convention held at Washington^ A. D. 1840: 8vo., Grigo- 
& Elliot, 1842. 

The proceedings of the Convention for the revision of the Pharmacopoeia, 
which met in January 1840, have been placed before the public through the 
medium of this and similar journals; it is therefore unnecessary to detail the 
initiatory steps taken to secure the execution of the work for which that body 
was organized. The only feasible plan was the one adopted — the appointment 
of a committee to whom the revision was entrusted, and from the hands of this 
committee the present revised edition has emanated. The delay in publication 
has arisen from circumstances which rendered it expedient for the advantage of 
the work, and which were inseparable from the course which the committee 
were authorized to pursue: the whole ground of the subject had not only to be 
gone over, but as assistance was solicited from associations capable of render- 
ing it, a length of time was unavoidably consumed in awaiting their contribu- 
tions, and these again required deliberate consideration. As the sources whence 
these contributions proceeded are the pharmaceiltical bodies of all the cities 
where such combinations exist, namely, of New York, Boston and Philadel- 
phia, and particularly as most important aid was afforded by the College of 
Pharmacy of the latter place, from which an amendment of the whole Pharma- 
copoeia, by a special committee, was obtained, the present work possesses the 
recommendation of being the production of both the bodies interested, the medi- 
cal and pharmaceutical, and by both should therefore be assumed as authority. 

The general outlines adopted in the edition of 1830 have been preserved in 



144 Bibliographical Notices. [J"^y 

the present; thus the two great divisions into the Materia Medica and Prepara- 
tions^ the subdivisions of the former into primary and secondary lists, the alpha- 
betical arrangement, and general system of nomenclature, have been retained; 
the alterations made involve details solely, and are in accordance with the expe- 
rience that ten years has communicated, and with the advance of scientific in- 
formation. 

In the materia medica lists, the changes that have been deemed expedient 
are, the introduction of new substances into one or the other, as they presented 
claims, founded upon their so far ascertained comparative merits, and the ejec- 
tion of others which have been proved to possess no determinate value, the ele- 
vation from the secondary to the primary list of such as have come into more 
general use, and consequently have an increased importance, the degradation 
from the primary to the secondary list of those which have been ascertained not 
to be worthy the position they held, and lastly, the removal from the Materia 
Medica to the class of Preparations, of substances which more properly belong 
to this head. It appears upon inspecting the appended tables, that 32 introduced 
medicines are named, 19 of which belong to the primary and 13 to the secon- 
dary list; the number that have been dismissed amount to 7; the articles that 
have been transferred to the primary list are calamus, cimicifuga, and lactuca- 
rium; those removed to the secondary are mucuna and iris florentina; two sub- 
stances have been placed among the preparations, acetate of potassa and ferro- 
cyanuret of iron. 

There is no greater evidence of the improvement of modern pharmacy than 
that presented in the character of the additions which have been made to the 
number of preparations, most of which have arisen from the progressive perfec- 
tion of chemical knowledge, and its happy adaptation to pharmaceutical pur- 
poses. No fewer than 80 have been introduced into the present edition of the 
Pharmacopoeia, which the demands of medicine have required, and which have 
not only been sanctioned by their position in European authoritative works of 
the same kind, but have been shown, by their general employment, to have more 
than ordinary pretensions to notice — most of them are essentially simple, or if 
compound, in strict relation with the principles of chemical combination. The 
most striking feature of pharmacy at the present day, is its extreme simplicity, 
exhibiting a vast difference in this respect from the polypharmacy of the last 
and preceding centuries. A still further enlargement of the catalogue of prepa- 
rations might, we conceive, have been advantageously ventured upon. Of the 
27 preparations dismissed, several are, no doubt worthy the fate appointed them. 
As this is a point, however, about which there is most difference of opinion, we 
question whether the repudiation in all instances will meet with entire appro- 
bation. 

We have long regarded the nomenclature of the U. S. Pharmacopoeia as 
chaste and classical, without redundancy, yet not meagre, always clear and 
expressive. Borrowed as it must be from the tributary sciences of botany, che- 
mistry, mineralogy and zoology, the alterations that have been made in it, have 
originated from the improvements and discoveries engrafted on them by the most 
distinguished savans of the age. For an explanation of the principles which 
constitute the basis of the system adopted, with an able and satisfactory expo- 
sition of its merits, we recommend not only the perusal, but the attentive study 
of that portion of the preface of the edition of 1830, appropriated to this topic, 
to every physician and apothecary. The improvements made in it are strictly 
in accordance with the principles first laid down, and consist of alterations of 
names to those now adopted generally, or rendered expedient by their brevity; 
thus cetraria has been assumed for lichen, mucuna for dolichos, and acacia for 
acaciae gurnmi, creta for calcis carbonas, marmor for calcis carbonas durus, &c. 
A marked improvement is also evident in the designation of the portion of plants 
which afford or yield medicinal articles, as, for instance, in the case of the um- 
belliferous plants, the " fruit" of which are designated instead of the inaccurate 
expression " seeds." 

With respect to what we regard an improvement on the old Pharmacopoeia, 



1842.] Bell on Regimen and Longevity, 145 

it will suffice to present a quotation from the preface as follows: — " Another 
novel feature of the present edition is the introduction, in connection with cer- 
tain articles of the Materia Medica and certain preparations, of brief notes indi- 
cating the readiest means of ascertaining their genuineness and purity. In this 
improvement the example of the London and Edinburgh Colleges, in the late 
edition of their respective Pharmacopcfiias have been followed, and use has been 
made of the rules given by these Colleges, so far as they are deemed appli- 
cable." 

The most decided characteristic of the new Pharmacopoeia, and that which 
strikes one accustomed to the previous edition, is the complete English garb in 
which it is put forth; this may not please those who are sticklers for an univer- 
sal language of science, and whose ideas of medicines and medicinal preparations 
are clothed in antiquated Latin, with its forced and sometimes ludicrous corre- 
spondence in tenses; but the argument of the committee is all sufficient to con- 
vince an unbiassed and unprejudiced mind of the correctness of the step they 
have taken, and in fact it is so pithily expressed, as to be unanswerable; it is as 
follows: " There seems to be no sufficient practical advantage to counterbalance the 
inconvenience of attempting to present ideas in a language which has no appropriate 
words to express them^ and the labour and expense incurred in printing tivice as 
much matter as is necessary to convey the meaning intended,'''' With so forcible a 
presentation of the case, it is hardly necessary to extenuate the omission by plead- 
ing the precedents afforded by the French Codex and Edinburgh Pharmacopoeia. 

The last point of novelty we have to notice, is the mode of preparation, to 
which has been given the title of "method of displacement:" this has now 
come into such general use, and is so highly thought of by the most skilful 
and best qualified pharmaceutists, as to have been almost entirely substituted 
by them for the former method by maceration and filtering. It requires consider- 
able practical tact, however, and considerable practice to adapt it to the cases 
where it can be employed, and the committee have therefore given the choice 
of the two modes of manipulation. An outline of the mode of conducting the 
new method has been judiciously presented. The subject for several years past 
has occupied the attention of pharmaceutists, and those who should wish to 
understand it thoroughly from details, we refer to the pages of the Journal of the 
Philadelphia College of Pharmacy, 

We cannot close this brief sketch, without expressing the opinion that the 
American medical and pharmaceutical public are under deep obligations to the 
learned and accurate individuals, who for a year and a half have devoted them- 
selves to the production of a work, which, whatever may be its defects, and 
however open to criticism isolated portions of it may be, still as a whole pre- 
sents a favourable evidence of the condition of science in the United States, and 
which cannot but be regarded as a monument of our intellectual condition. 

J.C. 



Art. XVI. — On Regimen and Longevity; comprising Materia Mimentaria^ Na- 
tional Dietetic usages, and the influence of Civilization on Health and the Dura- 
tion of Life. By John Bell, M.D., &c. Philadelphia: Haswell & Johnson, 
1842, 12mo. pp. 420. 

This interesting and instructive little volume recommends itself forcibly to 
the attention, not only of the general reader, but of the members of the medical 
profession. 

A correct treatise upon the Materia Alimentaria, embracing the results of the 
more recent and accurate observations in relation to the principal articles that are 
employed for food, or used as drinks by the various nations of the earth, as well 
as those leading principles bearing upon the subject of dietetics generally that 
have been developed by a more accurate acquaintance with the physiology of 
digestion and nutrition, has been lono- called for. Merely to say that such a 
No. VII.— July, 1842. 13 



146 Bibliographical Notices. [July 

treatise is presented in the work before us, would scarcely be doing strict justice 
to the author, and would certainly fail to convey to our readers a correct idea of 
its real character. Dr. Bell has embraced within the general scope of the sub- 
jects of which he treats, much curious and instructive matter, obtained from 
various sources of somewhat difficult access to the general reader as well as to 
a large portion of the members of our profession. 

" It has been the aim of the author," as he remarks in his preface, " to collect 
and arrange more abundant and diversified material, in order to guide his readers 
to a proper conclusion, than are met with in books on regimen. In place of fix- 
ing attention on the precise weight and measure of every article of food as it is 
brought to the table, and prescribing rigidly the allov,^ance to the invalid, he has 
extended the range of observation and inquiry, and showed how entire nations 
have lived and thrived on the very substance about which there was so much 
medico-culinary consultation and speculation. He has preferred setting forth 
the conditions and attainable means by which communities are kept in health, 
and longevity attained, to minute specifications of the arts by which a luxurious 
and pampered individual may compromise between his appetites and his health, 
and procure enjoyment, if it were possible, without complying with the laws 
through which alone it is procurable. But although the lesson be not specially 
directed to the invalid, it is so contrived as to reach his wants and strengthen 
his convictions of what is proper." 

*'An enlarged knowledge such as that furnished by a view of national dietetic 
usages, and of the wide geographical range and cultivation for food of various 
vegetable substances, will, it is believed, serve to dispel certain prejudices 
against some articles, on the regular and continued use of which,, for a period of 
more or less duration, the restoration to health of the invalid and the sick will 
greatly depend, more indeed, than on medicines, however skilfully prescribed 
and punctually and aflfectionately administered. But as already intimated, he 
does not profess to deal in specialities; his ambition is to influence the commu- 
nity at large, and particularly the young and inquiring, whose habits are not yet 
formed. For this purpose, he has placed before them a series of facts on the 
dietetic usages of both ancient and modern nations, and on the alimentary value 
and amount of the substances used for food in nearly all parts of the inhabited 
globe. Details of this nature are part of the physical history of man, which, 
ought to precede the study of his general or politico-civil history." 

" While advocating simplicity, the author also recommends variety in dietetic 
regimen: he thinks that meat should be sparingly used, but he displays the end- 
less variety of vegetable food, and the prodigal supply of fruits with a luxu- 
rious enjoyment in their free use — in the state in which, by a favouring climate 
and skilful industry, they are met with in nearly all parts of the world." 

" In sedulously avoiding all needless technicalities, the author has been mind- 
ful of the proper expectations of the general reader, while, at the same time, he 
has not thought himself free to pass over the explanations and illustrations fur- 
nished by organic chemistry, which merits a better fate than being thrust away 
in the farthest corner of our common works on general chemistry, or hurried 
over as a dispensable appendix to a course of public lectures on the science at 
large." 

" The free introduction of statistical calculations into these pages will often 
give the reader a clearer idea of the alimentary importance and commercial 
value of certain substances used for food than common notices or even any 
assertion of their extraordinary dietetic value could convey." 

These extracts from the author's preface present a very accurate outline of the 
character of the volume before us. In the description of the several articles of 
the materia alimentaria the author has followed nearly the same order with that 
adopted by writers on Materia Medica. The original locality and the countries 
where the cerealia, leguminosas, and nutritive tubers, and the nutritive and other 
fruits flourish; their composition as respects proximate principles, their aliment- 
ary value and absolute and relative quantities produced and available for home 
and foreign consumption, are duly noticed. Subsequently will be found the 



I 



1842.] Valleix's Practitioner's Guide, 147 

modes of preparation and combination of the chief nutritive grains, for common 
use and the wants of the invalid. 

In conclusion, we would recommend the work to the notice of our readers, 
as one calculated to impart more correct information as to the actual dietetic 
value of the various articles employed by mankind as well for food as drink, 
than can be acquired from most if not all the treatises upon diet and regimen 
which have preceded it. 

D. F. C. 



Art. XVII. — Guide du medecin pradicien ou resume general de jpathologie in- 
terne et de therapeutique appliquees. 
The Practitioner^ s Guide: a Practical Compendium of internal Pathology and The- 
rapeutics. — By F. L. J. Valleix. Paris, 1841, Nos. 1 and 2. 

The author has undertaken the present work in the hope of supplying a want 
in medical literature which all practical physicians must have experienced. For 
many years past the medical journals of every country have been filled with 
accounts of experiments in therapeutics conducted with g^reat care and product- 
ive of important results, but so scattered through the records of periodical lite- 
rature, that few physicians have either the time or the patience to study them 
critically, or even to read them at all. M. Valleix has undertaken the interest- 
ing but very laborious task of bringing together all the information about inter- 
nal diseases and their treatment which he could find dispersed throughout 
the works, both large and small, of all countries and ages; not as a mere com- 
piler however, nor in such a way as to perplex his readers with a long list of 
opinions or receipts, but by a critical examination of doctrines and precepts, to 
establish such principles as are adapted to the present state of medical science 
and art. 

This work differs from previous ones in the pains taken by the author to point 
out the diagnosis of each affection in so clear a manner as almost to prevent the 
possibility of mistaking it, by placing in contrast upon opposite sides of the page 
the prominent symptoms of diseases liable to be confounded, so that their dis- 
tinctive characters may be seen at a glance. The excellence of this expedient 
must recommend it to every practitioner, for although it is not intended to take 
the place of a more philosophical study of diagnostic signs, but rather to sug- 
gest and encourage such study, it refreshes the memory of the scientific man, 
and gives method to his knowledge, while it saves from the commission of seri- 
ous errors those who are either ignorant of the principles of medicine, or too 
indolent to apply them to practice. 

The therapeutic department of the work gives evidence of great research, and 
of sound judgment in appreciating the value of the several modes of treating 
each disease, whether they have been submitted to the test of experiment, or 
merely recommended by writers of authority. The indications to be fulfilled 
are deduced from a minute study of the diagnosis of the disease, and the treat- 
ment adapted to it is clearly pointed out, not only in general terms, but in a 
detailed account of the most efficient remedies, and the best mode of prescribing 
them. The frequent charge of feebleness urged against the practice recommend- 
ed in French works of practical medicine, does not seem to be applicable to that 
enforced in the present one, if we may judge from the two numbers of it before 
us. These refer to certain diseases of the nasal cavities, viz: epistaxis, coryza, 
and ozaena, in their several varieties and complications; the treatment of each. 
is discussed at greater length, more methodically, and, we think, more satisfac- 
torily than in any English treatise with which we are acquainted. If the suc- 
ceeding essays correspond to these in exactness and completeness, practitioners 
will have reason to thank M. Valleix for having assumed a task which very 
few could have been found to execute so skilfully, and the performance of which 
was loudly called for by the exigencies of medical art. 

A. S. 



148 Bibliographical Notices. [July 

Art. XVIII. — Quarterly Summary of the Transactions of the College of Physi' 
dans of Philadelphia, February, March, April, 1842, 8vo. p. 24. 

The communications read to the College the past quarter, consist of the an- 
nual reports on the Diseases of Women, by Dr. Warrington; on Meteorology and 
Epidemics, by Dr. Moore; and on the Diseases of Children, by Dr. Condie; a case 
of poisoning with laudanum, by Dr. Morris, and one of extensive destruction of 
the vesico-vaginal septum, by Dr. Ashmead. 

The reports are interesting, though perhaps less elaborate, than could be de- 
sired. 

The case of poisoning with laudanum we give in the relator's own words. 

" Mrs. A. intending to administer a dose of oil to her infant, four months old, to 
prevent griping, attempted to add to it two drops of laudanum. It escaped more 
rapidly than she wished from the vial, but supposing from the appearance, there 
might be about three drops, she gave it at a venture. The ch«ild soon fell asleep, 
and though it appeared nervous and twitched frequently, she felt no uneasiness 
till it was seized with convulsions, about three hours after the dose had been 
taken. I was then sent for, and found it with general convulsions, stertorous 
breathing, hot skin, pupils contracted to mere points — the stupor was so deep 
that it could not be aroused by any efforts I could make. I at once administered 
a dose of sulphate of zinc, which I had carried with me, and enema of strong 
salt and water hourly, a part of which was retained without exciting the least 
sensation. On examining the laudanum bottle, I found there were about twenty 
drops remaining at the bottom of an ounce vial, the sides of which were coated 
with a deposit of opium; the little fluid at the bottom being very turbid, and 
containing many fragments of opium of considerable size. I at once come to 
the conclusion that we had no means of estimating the amount of opium taken. 
In the first place, the uncertainty as to the number of drops, w^as very great; any 
one who has dropped laudanum into castor oil, may have observed how very de- 
ceptive is the appearance it presents. In addition to this cause of uncertainty, 
the turbid fluid was of much greater strength than the clear filtered tincture; but 
above all, the probability that a portion of solid opium had escaped with the 
fluid was so great as to amount almost to certainty. Under these circumstances, 
the stomach being little likely to respond to the impression of remedies, I intro- 
duced a large catheter into it, and injected a quantity of warm water. This was 
promptly returned through the lube, (and I may remark in passing, that I have 
before witnessed the same result,) so freely and promptly, that there was no oc- 
casion for any effort to draw it off by the syringe. The water was returned 
perfectly pure; there was, however, no mitigation of the symptoms. In the 
meanwhile mustard cataplasms had been applied to the extremities, and iced 
water repeatedly dashed upon the head, but neither was sufficient to arouse the 
child. On the contrary, the respiration became more slow — the skin cold, and 
the consciousness diminished. I had the child placed in a warm mustard bath, 
which excited one cry, the first and only token of sensation manifested for many 
hours. Dr. Hodge, who had been summoned to my aid, arrived at this juncture. 
The coldness of the surface and tokens of prostration becoming urgent, we 
agreed to administer brandy and water. In the effort to swallow the first tea- 
spoonful, convulsions set in, whether caused or not by some drops insinuating 
themselves into the larynx, it w^ould be difficult to say. Convulsion after con- 
vulsion ensued, destroying the power of deglutition entirely. Fearing, lest in 
the passage of the tube into the stomach for the purpose of stimulating the child 
by a continued use of the brandy, the spasm might be aggravated, we threw a 
table-spoonful of brandy mixed with a cupful of warm water into the rectum. 
The surface still continued cold; there was not even heat of the head; the breath- 
ing w^as much interrupted — the face livid. A warm mustard bath was again 
resorted to, but without any effect; the child was indeed taken from it, as we 
thought, moribund. The spasm increasing in violence, the action of the heart 
alone indicated the retention of life. While Dr. Hodge was employing friction to 



1842.] Transactions of the Medical Society of New York, 149 

the body, I thrust my finger into the mouth, and found the jaw rigid and the tongue 
thrust forcibly backward and upward against the palate. Tt occurred to me at 
the moment that even if an effort at respiration should be made, all access of air 
to the lungs was effectually prevented by this condition of the mouth; placing, 
therefore, two fingers upon the tongue and the thumb between the jaws, I held 
it forcibly open, at the same time requesting Dr. Hodge to compress forcibly the 
chest and belly so as to empty the lungs: this was repeated frequently, the 
elasticity of the cartilages, and the descent of the diaphragm causing air to be 
drawn into the lungs. This was repeated for at least three minutes, action of 
the heart only giving indication of the presence of vital power. At length a 
long sigh was drawn and natural respiration re-established. Still the surface 
remained cold, and there was no manifestation of a diminution of the influence of 
the opium, although between six and seven hours had elapsed since its adminis- 
tration. A large sinapism was applied to the anterior part of the body, which 
speedily induced redness, but without exciting the sensibility of the patient. It 
was then removed to the back without any more favourable result. Cold air 
was blown upon the face repeatedly with equal want of success. The mustard 
failing to excite permanent warmth, at the suggestion of Dr. Hodge, linen 
cloths were heated at the fire and applied so hot, that it was with difficulty they 
could be retained in the hands: by this means an artificial heat was communi- 
cated to the skin and the congestion of the great vessels relieved, the body soon 
becoming red as though covered with a vivid eruption. Before this was finally 
effected, convulsions again occurred, producing the same suspension of the re- 
spiration, and coldness and lividity of the surface, and this time there was no 
perceptible action of the heart. We all thought the child dead. The same pro- 
cess was again resorted to for the purpose of inflating the lungs, with the addi- 
tion of blowing into the throat whilst held open. So satisfied was I that the 
case was past recovery that I should have abandoned it as hopeless, but the 
active and untiring zeal of Dr. Hodge was not so easily subdued, and we per- 
severed again, and were both astonished and delighted to witness the re- 
establishment of natural respiration. For several hours we persevered in the 
application of the hot linen cloths — certainly the most effectual way of imparting 
heat to the body — and at ten o'clock at night, just eleven hours after the dose had 
been given, we left the child crying heartily for drink, and by the next morning 
it had entirely recovered from all the consequences of the dose." 

Dr. Ashmead's case of destruction of vesico-vaginal septum was so extremely 
extensive, that all attempts at remedying it have proved unsuccessful. 



Art. XIX. — Transactions of the Medical Society of the State of New York. Vol. 

V. Part II. 

This part of the Transactions contains the Annual Address, by Dr. J. B. Beck; 
a Review of Marshall Hall's views of an excito-motory system of Nerves, by Dr. 
Nr S. Davis; and Observations on the signs of live and still birth, by Dr. J. B. 
Beck; and an abstract of the proceedingrs of the society at its annual session, 
Feb. 1842. . 

The annual address is devoted to a history of American medicine before the 
Revolution, considered under three divisions — medical practice, medical litera- 
ture, and medical institutions. This is an extremely interesting paper, but not 
admitting of analysis, and it is too long to be transferred to our pages. We hope 
that it will be extensively circulated; we are sure that it will be read with plea- 
sure and profit. 

The observations on live and still birth are also interesting, and of great im- 
portance in their application to medical jurisprudence. We shall give them in 
full in our department of American Intelligence. 

13*° 



]50 



Bibliographical Notices, 



[July 



Art. X.'K.'— Annual Report of the Surgeon General of the United States Army, 

From this report we glean the following particulars. 

The whole number of cases of sickness during the year ending 30th Septem- 
ber 1841, was 38,559, of which number 37,499 occurred within the year, and 
the rest were remaining from the preceding one. 

Of the whole number reported sick, 36,374 have been restored to duty; 320 
have been discharged the service; 30 have deserted, and 388 have died. 

The mean strength of the army, according to the medical returns, having been 
9,748; the proportion of cases to men in service was 396 per cent., or nearly 4 
to 1. The aggregate of deaths was 1 to 25^, or nearly 4 per cent.; and the pro- 
portion of deaths to the number of cases treated 1 to 99f, or a fraction more 
than 1 per cent. 

" Besides the diseases incident to the climate and service of Florida," it is 
remarked, "the epidemic fever, which has proved so fatal at the 'South during 
the past season, has also prevailed among the troops serving in the territory. 
The average strength of the army in Florida during the year, being about 4,738, 
the number of cases of sickness amounted to 21,027, exhibiting a proportion of 
cases to the number of officers and men of nearly 4| to 1, or 443 per cent. The 
deaths being 254, presents a ratio of mortality to the number of men 1 to 18|, or 
b\ per cent.; and the proportion of deaths to the number of cases treated of 1 to 
82|, or \\ per cent. Oi fourteen candidates examined for admission into the 
army as assistant surgeons, six only were approved. 

The following table exhibits the prevalent diseases, the mortality from 
each, &c. 





No. 


Mortality. 




No. 


Mortality. 


Febris quot. inter. 


4,843 


5 


Asthma 


24 





do. tert. do. 


4,427 


2 


Laryngitis 


26 





do. quart, do. 


157 


21(cong 


.) Cynanche parotid. 


33 





do. remittens 


2,509 


43 


Meningitis and phrenitis 7 


2 


do. cont. com. 


310 


2 


Apoplexia 


10 


7 


do. typhus 


47 


10 


Paralysis 


12 





do. icterodes 


29 


6 


Epilepsy 


112 





Vaccinia 


12 





Chorea 


3 





Rubeola 


31 





Tetanus 


1 


1 


Scarlatina 


2 





Mania 


29 


1 


Erysipelas 


50 


1 


Delirium tremens 


150 


3 


Cynanche Tracheal. 


17 





Neuralgia 


40 





Tonsilitis 


251 





Cephalalgia 


568 





Dyspepsia 


152 





Nyctalopia 


41 





Colica 


415 





Nephritis 


8 


1 


Haematemesis 


2 





Cystitis 


1 





Gastritis 


113 


1 


Ischuria and Dysuria 


25 





Peritonitis 


15 


5 


Eneurisis 


17 





do. acuta 


7 


2 


Diabetes 


1 





Dysenteria acuta 


2,834 


38 


Calculus 


1 





do. chronica 


391 


55 


Syphilis primitiva 


121 





Diarrhcsa 


3,474 


44 


do. consecutiva 


61 


1 


Obstipatio 


1,062 


1 


Ulcus penis non syph 


6 





Cholera Morbus 


210 


1 


Gonorrhoea 


421 





Hepatitis acuta 


27 





Orchitis 


89 





do. chronica 


23 


1 


Strictura urethra 


13 





Icterus 


47 





Anasarca 


39 


3 


Catarrhus 


2,778 


3 


Ascites 


20 


2 


Bronchitis acuta 


119 


7 


Hydrothorax 


2 


4 


Pleuritis 


210 


4 


Hydrocele 


2 





Pneumonia 


139 


12 


Hypertrophy of heart 


3 


1 


Haemoptysis 


29 


3 


Rheumat. acuta 


700 





Phthisis pulraonalis 


64 


38 


do. chronica 


446 


3 



1842.] 



Andral on the Blood in Diseases, 



151 





No. 


Mortality. 




No. 


Mortality. 


Podagra 


5 


1 


Prolapsus ani 


5 





Pernio 


135 


1 


Vermes 


16 





Phlegmon and abscess 938 


3 


Scrofula 


19 





Paronychia , 


98 





Scorbutus 


104 


3 


Fistula 


16 





Cachexia 


21 





Ulcus 


531 





Debilitas 


376 





Ambustio 


137 


1 


Varix 


7 





Vulnus incisurn 


752 


2 


Tumores 


82 





do. punctum 


97 





Hernia 


81 





do. sclopelicum 


108 


14 


Exostosis 


7 





Contusio 


1,167 


3 


Necrosis 


5 





Sub-luxatio 


. 387 





Atrophia 


1 





Luxatio 


31 





Amputatio 


8 





Fractura 


69 





Serpentis morsus 


7 





Concussio cerebri* 


3 





Punitio 


32 





Pericarditis 


2 


1 


Intemperance 


125 


9 


Aneurisma 


1 





Morbi cutis 


181 





Ophthalmia 


859 


1 


Morbi Varii 2,964 


8 


Amaurosis 


6 





Cause not reported 




Otitis 


95 





Dry gangrene 






Splenitis 


28 





Intus. susceptic 


( 




Epistaxis 


5 





Marasmus 






Hemorrhois 


160 


1 


Hydrocephalus 






Art. XXI.— On the 


Physical Alterations of the Blood andJlnima 


dfluic 


Is in disec 



By M. Andral. {Frov. Med. and Surg. Journ.) 

In our preceding number we commenced an analysis of these lectures, and 
we shall now proceed with the task. 

M. Andral recognises the two divisions of fevers, idiopathic and symptomatic, 
and states that the former may exist, 1st, without any lesion of the solids; 2d, 
with an evident lesion, but one which is not the cause of the disevise, and in- 
stances as an example of this last, the ulceration of the intestinal glands in 
typhoid fever, which, he states, are the effects of some cause v;^ith which he is 
unacquainted. 

The following, according to M. Andral, are the states of the blood in fever. 

" 1st. If the fever be symptomatic of inflammation, the quantity of fibrin is 
augmented; but this increase does not depend on the fever, for there are several 
fevers, just as intense and long continued as the inflammatory, in which we ob- 
serve no increase of fibrin; the cause of the increased quantity of fibrin is not 
easily discovered, and to assign any particular one, in the present state of our 
knowledge, would be hasty. 

"2d. When the fever does not depend on inflammation, we have no aug- 
mentation of fibrin, be it ever so severe or prolonged. 

"3d. Should simple fever become complicated, during its course, with any 
inflammatory affection, then the fibrin increases. 

" 4th. Fever and inflammation may co-exist, the latter being an essential ele- 
ment of the former, as inflammation of the skin in small-pox, measles, scarlatina, 
&;c.; these affections of the skin, which perhaps should not be ranged under 
inflammations, are unattended with the characteristic increase of fibrin; the same 
remark applies to ulceration of the intestines in typhoid fever; however tena- 
ciously some physicians may adhere to the inflammatory doctrine of typhoid 
fever, it is certain that the ulcerations of the intestinal glands are not accompa- 
nied by that increase of fibrin which attends other inflammatory diseases. Hence, 
whenever fever co-exists with inflammation, and together with it constitutes 
one of the elements of the disease, the fibrin of the blood is not increased; for 



152 Bibliographical Notices* [July 

example, small-pox, typhoid fever, &c. But it is far different when inflamma- 
tion spring's up during the course of the fever, or is one of its effects." 

The chief cause of a certain class of fevers seems to be, Mr. A. conceives, an 
excessive richness of the blood. "Inflammatory fevers," he says, "of a few 
days' duration, depend upon this cause; the ancients considered this as an idio- 
pathic fever, but it is really a symptomatic one. But we may ask, does the cause 
of the disease reside in the solids, or in the fluids'? To excessive richness of the 
blood, as just mentioned, the disease has been attributed, but this richness con- 
sists in an increase of the globules, not of the fibrin. When Pinel published his 
nosography, the humours were altogether neglected, yet he located inflammatory 
fever in the blood-vessels; at a later period, it was connected with gastritis and 
enteritis; afterwards with inflammation of the heart and arteries; Tomasini still 
adheres to the latter opinion. It has also been denominated plethoric or hy- 
peraemic fever, in conformity with the ideas of humoral pathology. 

" However, this is not the only fever in which the globules are augmented; 
the same increase occurs at the commencement of typhoid fever, measles, and 
scarlatina. We do not find this augmentation of globules in inflammation; it 
exists in the middle period of fevers. 

" In continued fevers, the febrile movement persists even when the globules 
have fallen to their normal standard, or below it; as a remarkable illustration, 
M. Andral cites chlorosis, in which the quickness of the pulse augments in pro- 
portion to the diminution of the globules and progress of the disease; febrile 
symptoms now appear, the skin gets hot, the pulse excessively frequent, and 
the patient dies. After death, we find no very evident traces of disease in the 
viscera. 

"Fever may exist with every possible condition of the globules, (normal 
state, increase, diminution;) we may admit, although we cannot prove it clearly, 
that some fevers depend on increased richness of the blood; others, again, exist 
with a remarkable diminution of the globules; in a third class the fever persists, 
although the globules have been diminished by bleeding and abstinence. 

" If we now examine, in a comparative way, the condition of the various ele- 
ments of the blood during fever, we shall find that the simple presence of fever 
never determines an increase in the quantity of fibrin; that fever may exist, 1st, 
when both fibrin and globules are in normal quantity; 2d, when the globules 
alone are increased, the fibrin remaining unchanged. The quantity of fibrin 
may fall, during typhoid fever, even so low as 0.9; at an early stage of the dis- 
ease, or when it is mild, the fibrin remains unchanged, but falls as the fever is 
aggravated; when it assumes an ataxic character, and symptoms of prostration 
ensue about the fifteenth day, the fibrin also falls, and hence we might be in- 
clined to think that its diminution depended on the duration of the disease; but 
this is not the case, for in acute inflammation the quantity of fibrin is increased, 
even at an advanced period, and in spite of bleeding and abstinence from food; 
in fact, the condition of the blood in typhoid fever is exactly the reverse of that 
in inflammation; in the former, while the globules and fibrin are undergoing a 
diminution, the quantity of serum is increasing; hence, this is a disease in which 
the blood is remarkably impoverished. 

^<' Physical formation of the blood in fever. — During fever, the separation of the 
blood into serum and clot is imperfect, because the latter is soft and retains the 
serum. The serum, again, is frequently of a reddish colour, from an admixture 
of globules, and the clot is large; this latter condition may depend — 1st, on the 
increased quantity of globules which frequently attends the development of 
fever; 2d, on the quantity of serum retained by the clot; 3d, on the diminution 
of fibrin, and consequent want of contractility in the clot. The coagulum may, 
in many cases, preserve its usual degree of firmness, but the latter is never in- 
creased; more frequently it is diminished; or the clot may be quite soft and dif- 
fluent; a perfect buffy coat never forms during fever, unless there be inflamma- 
tion; in typhoid fever and small-pox we find a thin, greenish layer, which is a 
mere rudiment of buflT. 

" Connection between the state of the blood and the various symptoms of fever, — 



1842.] Andral on the Blood in Diseases. 153 

Fever may run through its different stages without presenting any complication, 
but in other cases we have a series of phenomena, which are, in some measure, 
connected with the febrile disorder, though not actually produced by it; these 
are inflammation, congestion, hemorrhage, and gangrene. 

Some inflammations occur accidentally, during the course of fever, and are 
not attended with any change in the state of the blood; other febrile disorders, 
small-pox, measles, &c., are always accompanied by certain lesions which are 
commonly regarded as inflammatory; but in these also, the blood undergoes no 
change; finally, in other fevers we have inflammation and its characteristic effects 
on the blood. 

" Congestion is a frequent complication of fever, and if we endeavour to trace 
a connection between this congestion and the state of the blood, we are led to 
conclude that the former depends on a loss of equilibrium between the fibrin and 
globules. The spleen and other parenchymatous organs are very often the seat 
of congestion in typhoid and typhus fever, and in small-pox; now the alteration 
of the blood observed in patients labouring under those diseases, is a diminution 
in the quantity of fibrin as compared with the globules. 

*' Hemorrhage, also, is a frequent complication of fever, while it rarely occurs 
in inflammation; if we compare typhoid fever and pneumonia together, this fact 
will at once strike us; the severity of the hemorrhage, likewise, seems to follow 
the violence of the fever, as exemplified in typhus fever, plague, and yellow 
fever. 

*' Gangrene occurs less frequently than hemorrhage, congestion, or inflamma- 
tion, but often occurs in typhus fever and plague; we may also remark, that dis- 
eases accompanied by carbuncle, acute glanders, and the fever of purulent 
absorption, are general febrile disorders which probably depend on alterations 
of the blood. The ancients admitted morbid conditions of the blood under the 
circumstances just alluded to; they denominated "putrid" that state of the sys- 
tem in which the vital force seemed to sink under the influence of physical 
changes and the decomposition of the blood. Bordeu taught that typhoid fever 
was connected with a general state of the system, w^hich he calls acute scurvy? 
and this expression is, in some measure, correct, so far as the state of the blood 
is concerned. A diminution in the quantity of coagulable matter of the blood! 
is a general character of all fevers; in fevers from miasma we have, first, ab- 
sorption of the poison; and next, diminution of fibrin, the only striking change 
which the observant physician can discover. The same character exists in. 
typhoid fever, but we cannot assert that it is the cause of the disease, since it is 
developed with it, and becomes more evident only as the symptoms increase. 

" From the preceding observations, we may deduce some very serious objec- 
tions to the different modes of treatment of typhoid fever. Were we to consider 
the state of the blood only, we should reason in the following manner: in in- 
flammatory fever there is an augmentation of the globules, and as blood-letting 
is the best mode of reducing the quantity of globules, we should bleed the pa- 
tient. In typhoid fever we have a similar increase of globules, and should 
therefore apply the same remedy; but we must never forget in typhoid fever the 
general derangement of the economy which precedes the alteration in the blood, 
and we cannot say what effect blood-letting may have on this unknown element 
of the disease; hence we conclude, that the treatment of typhoid fever can only 
be established by clinical experience." 

The condition of the blood in injlammation, M. A. states, differs according as 
the latter is acute, subacute, or chronic. 

The fibrin is always increased during inflammation, and may vary from 4 
to 10. 

"The globules are not necessarily augmented; generally speaking, they retain 
their normal standard; in rare cases are increased; in others diminished. As 
the inflammation advances the globules may fall, but this is the effect of blood- 
letting and abstinence. We have already seen that plethoric persons are not 
more disposed than others to inflammation. 

" Solid contents of serum. — The albumen may be increased, but not necessarily^ 



154 Bibliographical Notices, [July 

and the inflammation may attain a very high degree of intensity, without aug- 
mentation of the serum. 

'"'' Physical properties. — The clot is generally very firm and tenacious, because 
the fibrin has expelled a great portion of the serum; in fever, on the contrary, 
the serum is retained, and renders the clot soft and voluminous. In inflamma- 
tion the clot is small; for as it contains a large proportion of fibrin, the globules 
are firmly pressed together by the contraction of the coagulatiug part of the 
blood." 

M. Andral thus explains the phenomena of inflammation. " Whenever in- 
flammation terminates in suppuration, the quantity of fibrin increases; hence, 
the formation of pus and augmentation of fibrin accompany one another; we 
might, indeed, add another phenomenon, viz. the formation of false membranes. 
The fibrin is also augmented in cases where the serum is turbid and mixed with 
flocci; on analysing false membranes they are found to be composed of fibrin, 
and this is confirmed by a comparison of false membranes with the buffy coat 
of the blood, to which they bear a perfect resemblance. 

" Pus is a compound fluid, the composition of which is not yet accurately 
known; we are unable to assert that it is formed of fibrin, but in certain kinds of 
pus we find a white substance analogous to fibrin. We may now ask, how 
does the composition of the blood throw any light on the formation of false 
membranes? In the first place, we are never able to detect any increase in the 
quantity of fibrin until the symptoms of inflammation are quite patent; perhaps 
the increase is too small in the beginning to be appreciated. In some cases we 
cannot discover the exciting cause of inflammation, in others we can, as a blister, 
for example; here we find no antecedent change of the blood; hence we may con- 
clude that inflammation arises independently of any precedent modification of 
the blood; the same occurs in cases of burns. 

" Fever exercises no influence on the changes which lake place in the compo- 
sition of the blood. According to Tomasini, inflammation cannot arise unless 
the constitution has first undergone some change; every local disease is preceded 
by some general condition, which the Italian physician calls diathesis." 

M. A. next examines how far the state of the blood may throw light on the 
treatment of inflammation. " Were we to depend," he observes, " on the latter, 
we should conclude that blood-letting is less indicated in inflammation than in 
fever, because its effect is to diminish the quantity of globules, and not the fibrin; 
but, again, we would observe, the value of bleeding must be decided by expe- 
rience. Medical opinions are much divided on the efficacy of revulsives in in- 
flammation; some assert that it is increased by blisters; this idea is principally 
supposed by Tomasini; others think, on the contrary, that blisters act bene- 
ficially, by determining an irritation of the skin; others, finally, would limit the 
use of blisters to certain periods of inflammation. Experience, in fact, shows 
that blisters aggravate inflammation, if applied at an early period: even in chro- 
nic inflammation they are injurious when unseasonably employed. Reasoning 
on the facts derived from humoral pathology, we should say that large blisters 
must increase the quantity of fibrin, since they excite local inflammation, occa- 
sionally accompanied by fever; but independent of this first effect, we have ano- 
ther, consisting in the abstraction of fibrin from the circulation; but this second 
effect is never sufficiently great to counteract the former one. 

" Boiling water, tartar emetic, &c. act in the same way as blisters; sometimes 
nothing but serum is removed from the blood; in other cases serum and fibrin. 
The dermis acts as a kind of filter, and prevents the globules from passing 
through. Some remedies have the effect of determining perspiration to the 
skin; others determine to the intestines. Aloes produce copious liquid stools, 
composed chiefly of serum coloured by the bile: other purgatives excite the 
secretion of mucus, or merely of bile; it is difficult to say what effects such 
remedies produce on the blood. Some physicians regard the preparations of 
mercury as antiphlogistic. Granting this to be the case, can we explain their 
action? Mercury, it is said, renders the blood less coagulable, in other words, 
diminishes the quantity of fibrin; but this is mere hypothesis." 



I 



1842.] 155 

SUMMARY 

OF THE 

IMPROVEMENTS AND DISCOVERIES 

IN THE 

MEDICAL SCIENCES. 

ANATOMY AND PHYSIOLOGY. 

1 . Abstract of Mr. Goodsir^s paper on the Ultimate Secreting Structure, and on 
the laws of its Function. (Read at the Royal Society of Edinburgh on the 30th 
March, 1842.) After referring- to the labours of those anatomists who had verified 
Malpighi's doctrine of the follicular nature of gland ducts, the author alluded to 
Parkinje's hypothesis of the secreting function of the nucleated corpuscles 
which line these ducts. In a rapid sketch of the results of inquiries since the 
appearance of Miiller's work " De Penitiore Structura Glandularum," and more 
particularly of the observations of Henle and others on the closed vesicles which 
are situated at the extremities of certain ducts, Mr. Goodsir stated, that no anat- 
omist had hitherto "proved that secretion takes place within the primitive nu- 
cleated cell itself, or had pointed out the intimate nature of the changes which 
go on in a secreting organ during the performance of its function." 

Numerous examples were now given of secretions detected in the cavities of 
nucleated cells of various glands and secreting surface. Among these secretions 
were the ink of the cephalopoda and the purple of janthina and aplysia,- bile in 
an extensive series selected from the principal divisions of the animal kingdom; 
urine in the mollusk; milk, &c. 

The wall is believed by the author to be the part of the cell engaged in the 
process of secretion. The cavity contains the secreted substance, and the nu- 
cleus is the reproductive organ of the cell. A primitive cell engaged in secre- 
tion is denominated, by the author, a primary secreting cell; and each cell of 
this kind is endowed with its own peculiar property, according to the organ in 
which it is situated. The discovery of the secreting agency of the primitive 
cell does not remove the principal mystery in which the function has always 
been involved; but the general fact that the primitive cell is the ultimate secret- 
ing structure, is of great value in physiological science, inasmuch as it connects 
secretion with growth as functions regulated by the same laws, and explains one 
of the greatest difficulties in physiology, viz. why a secretion flows from the 
free surface only of a secreting membrane — the secretion exists only on the free 
surface inclosed in the ripe cells which constitute that surface. 

The author then proceeded to the consideration of the origin, the develop- 
ment, and the disappearance of the primary secreting cell, a subject which 
necessarily involved the description of the various minute arrangements of 
glands, and other secreting organs. After describing the changes which occur 
in the testicle of the squalus cornubicus, when the organ is in a state of functional 
activity, and in the Viver of car cinusmoenas, it was stated that these were selected 
as examples of two orders of glands, denominated by the author vesicular and 
follicular. The changes which occur in the first order of glands consist in the 
formation and disappearance of closed vesicles or acini. Each acinus might be 
first a single cell, denominated by the author the primary or germinal cell; or, 



156 Progress of the Medical Sciences, [July 

secondly, of two or more cells enclosed in the primary cell, and produced from 
its nucleus. The enclosed cells he denominates the secondary cells of the aci- 
nus, and in the cavities of these, between their nuclei and cell walls, the pecu- 
liar secretion of the gland is contained. The primary cell, with its included 
group of cells, each full of secretion, is appended to the extremity of one of the 
terminal ducts, and consequently does not communicate with that duct, a dia- 
phragm formed by a portion of the primary cell wall stretching across the pedi- 
cle. When the secretion in the group of included cells is fully elaborated, the 
diaphragm dissolves or gives way, the cells burst, and the secretion flows along 
the ducts, the acinus disappearing, and making room for a neighbouring acinus, 
w^hich has in the mean time been advancing in a similar manner. The whole 
parenchyma of glands of this order is thus, according to Mr. Goodsir, in a con- 
stant state of change — of development, maturity, and atrophy, — this series of 
changes being directly proportional to the profuseness of the secretion. 

In the second order of glands, the follicular, as exemplified in the liver of car- 
cinus^ the germinal cell or spot is situated at the blind extremity of the follicle, 
and the secreting cells, as they advance along the follicle, become distended 
with their peculiar secretion. 

Among other general conclusions deducible from these observations, it ap- 
peared that ducts are to be considered as inter-cellular passages into which the 
secretions formed by cells are cast. 

Finally, the author inferred from the whole inquiry, 1st, That secretion is a 
function of, and takes place within the nucleated cell; and, 2d, Growth and 
secretion are identical, — the same process under different circumstances. — Lon, 
and Edin. Montfily Journ. Med. Sci., May, 1842. 

2. Structure of the human hidney and the changes it undergoes in the granular 
degeneration. — Mr. Goodsir submitted to the Medico-Chirurgical Society of 
Edinburgh April 6th, 1842, the result of his researches into the structure of the 
healthy human kidney, and into the changes which it undergoes in the granular 
degeneration described by Dr. Bright. Without denying the existence of occa- 
sional blind extremities of the tubuli uriniferi, the result probably, of arrested 
development, the author stated that he had never seen the ducts terminating in 
this way. He then described a structure, which appears hitherto to have been 
overlooked by anatomists, namely, a fibro-cellular framework, which pervading 
every part of the gland, and particularly its cortical portion, performs the same 
important part in the kidney, which the capsule of Glisson does in the liver, 
forming a basis of support to the delicate structure of the gland, conducting the 
blood-vessels through the organ, and forming small chambers in the cortical 
portion, in each of which a single ultimate coil or loop of the uriniferous ducts 
is lodged. Mr. Goodsir believes, that the urine is formed at first within the 
so-called epithelium cells of the ducts, and that these burst, dissolve, and throw 
out their contents, and are succeeded by others which perform the same func- 
tions. The urine of man has not been detected by the author within the cells 
which line the ducts, but he has submitted to the Royal Society of Edinburgh, 
within the last few weeks, a memoir, in which he has proved that the urine, bile, 
milk, as well as the other more important secretions in the lower animals, are 
formed within the nucleated cells of the gland ducts. He believes, therefore, 
that the urine of man is poured at first into the cavities of the nucleated cells of 
the human kidney. 

In proceeding to describe the morbid changes which he had detected in kid- 
neys, in the various stages of the granular disease of Bright, the author of the 
paper did not pretend to decide, whether these changes originated in inflamma- 
tion, or simply in congestion of the gland. He reminded the society of those 
changes, which at a former meeting he had announced as occurring in the vesi- 
cular glands of the intestine during fever, namely, the formation and progressive 
increase of nucleated cells, (probably aberrant forms of the epithelium which 
line the vesicles,) within the vesicles of the patches. He now stated, that 
granular degeneration of the kidney was a similar decrease; that it consisted 



1842.] Anatomy and Physiology. 157 

essentially of the formation of nucleated cells within the uriniferous ducts; that 
these new cells were principally confined to the ultimate loops of the duct; 
but that in advanced stag-es of the disease, they might be formed even in the 
tubes of the pyramids of Ferrien, — that when a sing-le ultimate loop of the uri- 
niferous ducts was gorged or distended with the increasing mass of germinating 
cells, or when two or more neighbouring loops were in this condition, the little 
mass constituted one of the granulations characteristic of the milder forms of the 
disease, — that when throughout the gland, or in certain portions of it, the ger- 
minating masses had so far distended the ducts and loops, as to cause their dis- 
appearance, and to induce absorption of the walls of the little chambers of the 
fibro-cellular capsule, and consequently of the uriniferous ducts, the whole of the 
cortical portion of the gland, or that part of it more particularly affected, as- 
sumed the appearance presented in the more advanced stages of the disease. If 
the patient survives the stage last described, the kidney becomes partially or 
wholly atrophied, — a change due to the contraction of fibrous tissue, produced 
either from the cells which constitute the disease, or from cells resulting from 
effused fibrin. With the exception of the primary engorgement of the capillary 
system, and of the Malpighian corpuscles, and their subsequent diminution, 
Mr. Goodsir had not observed any very marked change in the vascular system 
of the kidney during granular degeneration of the organ. 

In proceeding to describe certain parts of the healthy and morbid structure of 
the human liver, the author observed, that very little remained to be done in 
reference to this gland, since the very admirable researches of Mr. Kiernan. In 
regard to two parts of the structure, however, we were yet quite in the dark, 
namely, the mode of termination of the hepatic ducts, and the connection be- 
tween them and the nucleated cells of this organ. He had been able, after con- 
siderable difficulty, to verify Mr. Kiernan's supposition, that the hepatic ducts 
terminate by a network within the lobules of the liver, around the intra-lobular 
"veins. But the most important feature in the observations of the author, was 
the detection of the real connection between these ultimate ducts and the nu- 
cleated cells. These he found to be grouped in the form of acini on the sides 
of the duct. Each acinus might consist, first, of a single cell, denominated by 
the author the primary or germinal cell of the future acinus; or, secondly, of two 
or more cells enclosed in the primary cell, and produced from its nucleus. The 
enclosed cells he denominates the secondary cells of the acinus; and in the cavi- 
ties of these, between their nuclei and cell walls, the bile and a few oil-like 
globules are contained, as he had already stated in the memoir above alluded to. 
The primary cell, with its included group of cells, each full of bile, is appended 
to the side of the remote ducts, and, consequently, does not communicate with 
that duct, a diaphragm formed by a portion of the primary cell wall stretching 
across the pedicle. When the bile in the group of included cells is fully elabo- 
rated, the diaphragm dissolves or gives way, the cells burst, and the bile flows 
along the ducts; the acinus disappearing, and making room for a neighbouring 
acinus, which has in the mean time been advancing in a similar manner. The 
whole parenchyma of the liver, then, is, according to Mr. Goodsir, " in a con- 
stant state of change, — of development, maturity, and atrophy; this series of 
changes being directly proportioned to the profuseness of the secretion of bile." 
The author now stated, that he found himself anticipated by Mr. Bowman, in 
regard to one of the morbid conditions of the human liver, namely, the fatty 
liver. He had, however, much pleasure in confirming that gentleman's obser- 
vation {Lancet^ Jan. 1842) as to the fat being deposited within the nucleated 
cells of the organ, and to be considered, in fact, as a redundancy of the oil 

f lobules naturally existing in these cells. It was then stated, that as in the 
idney, so in the liver, contractile fibrous tissue might be developed, and pro- 
duce partial or complete atrophy. Dr. Carswell had already indicated this as 
existing in cirrhosis. The matter of which the rounded masses in cirrhosis con- 
sist, was not considered by Mr. Goodsir as a new deposit, but merely as the 
natural tissue of the liver, altered by the pressure exerted by their fibrous enve- 
lopes. These alterations consist in constriction, more or less powerful, of the 
No. Vn.— July, 1842. 14 



158 Progress of the Medical Sciences, [J»ly 

vessels and ducts which pass out and in to the rounded mass; the necessary 
difficulty with which the circulation is carried on, and the bile advanced along 
the ducts; and, latterly, in a change in the constitution of the nucleated cells 
themselves, which, instead of being- distended with bile containing oil-like 
globules, contains matter of a darker colour and less oil. The cells may at last 
contain matter perfectly black, and then the rounded mass assumes the appear- 
ance of a melanotic tubercle, the black cells in some instances becoming pyri- 
form and caudate. The author did not state the exact nature of the proximate 
cause of these various changes in the liver, although he is inclined to believe 
that the forms of cirrhosis and melanosis are due to the contractile tissue, as a 
product of inflammatory action more or less acute. The action of remedies, par- 
ticularly of mercury, would appear to corroborate this opinion. Finally, he con- 
cluded, from the observations which he had made on the morbid anatomy of the 
human liver and kidney, that certain of the diseases of these organs are due to 
the development of new cells and new matter, within the ducts and nucleated 
cells of the organs, in accordance with the normal laws of cellular development, 
this cellular vegetation at last destroying, more or less completely, the natural 
tissue of the organ. — Ibid, 

3. Arrangement of the eighth pair of nerves. — Mr. Spence exhibited to the 
Med. Chir. Soc. of Edinburgh (April 6, 1842), the preparation and drawings of 
a dissection of the eighth pair of nerves, showing that all the filaments of the 
par vagum did not pass the ganglia on that nerve; but that a portion of the 
vagus could be traced passing over its superior ganglion, and that this portion, 
after having been joined by the internal root of the spinal accessory, and giving 
oflf the pharyngeal branches of the vagus, likewise passed over its second gan- 
glion, and could be traced into the recurrent laryngeal nerve. Mr. S. remarked, 
that this anatomical arrangement of the nerve satisfactorily accounted for the 
seemingly anomalous fact, that the vagus, an apparently ganglionic nerve, 
should send off motor branches, as these dissections showed that it contained 
motor filaments distinct from the ganglionic portion, and also distinct, for some 
distance, from the superior filaments of the accessory described by Bendz. He 
then made some remarks on the experiments of M. BischoflT, Dr. J, Reid, and 
M. Longet of Paris, to show that these experiments and the anatomy mutually 
illustrated each other. — Ibid, 

4. Singular case of Monstrosity. — Dr. Rodenstab, in a communication, enti- 
tled Practical Remarks on Labour, published in the " Neue Zeitschrift, fur die 
Geburtskunde," has given the' particulars of the birth of a living monstrosity, 
without any cranium. The mother was delivered by the forceps. A fortnight 
after birth, points of ossification were developed in different parts of the head, 
and at the end of two months, the cranium resembled that of an ordinary newly- 
born infant. The child, a male, three years old at the date of the report, difiers 
only from other children by the great size of the fontanelle. — Prov. Med, and 
Surg. Journ. May 14, 1842. 

5. Experiments on the Saliva obtained from a man labouring under fistula of the 
right parotid duct near its extremity. By Messrs. Garrod and Marshall. — 
Reactions. — Tiedemann and Gmelin found it generally slightly alkaline, some- 
times neutral, but never acid. Schultz found it acid in the adult when retained 
in the mouth — alkaline in children. Mitscherlich, who observed it in a case of 
parotid fistula, found it acid when not eating, alkaline during a meal. Other 
observers have come to similar conclusions; but most consider that it is capa- 
ble of varying under very slight circumstances. Messrs. Marshall and Gar- 
rod found that between meals the fluid issuing from the fistulous opening, 
amounting to two or three drops in the quarter of an hour, was always acid, but 
within half a minute after a morsel had been taken it became neutral, and within 
the minute alkaline: it soon became strongly alkaline, and remained so till the 
completion of the meal. About ten minutes after the meal it again became neu- 



:v:^ 



1842.] Anatomy and Physiology. 159 

tral, and acid in about twenty minutes, and remained so till the next meal. The 
only exceptions were during cough, which, when slight, produced an increased 
flow of saliva; and it often became neutral for a minute, but soon returned to 
its acid state. When, however, the cough was long continued, the fluid not 
only became neutral but even alkaline; but it soon returned to its acid state 
when the fit of coughing was over. 

When the fluid issuing from the fistula was acid, then also blue test-paper be- 
came reddened when applied above and below the tongue, and also to the open- 
ing of the other parotid duct; and when the fluid was alkaline at the fistula, so 
were the surfaces above mentioned. 

These experiments were repeated many times in the presence of Dr. Sharpey, 
Mr. Listen, and many other gentlemen, and always with the same results. 
Once only was the fluid from fistula (during rest) found to be alkaline, and then 
it was found to be owing to a drop of pus, which, being removed, the acid indica- 
tion was given. 

Reasoning on these facts, and not thinking it probable that a secretion could 
change from acid to alkaline in so short a time, the more from its not being 
excited by mental emotions only (as the sight of food, &c.) but also by cough- 
ing, or motion of the masticating organs, Mr. Garrod endeavoured to explain it 
otherwise; viz., by supposing that the acidity was owing to the mucous secre- 
tion of the duct, &c., and that the true saliva was always alkaline. Then, 
when the saliva is flowing but very slowly, as between meals, &c., the alka- 
linity of the saliva would not be able to neutralise the acid mucus constantly 
secreted, and the indication, therefore, would be acid; but when the saliva was 
excited to an increased flow, this first neutralised, then more than neutralised, 
the acidity of the mucus, and the indications would be first neutral, then alka- 
line; and, of course, when the flow of saliva was diminished again, it would 
pass through the same changes. But it was found that the fluid became alka- 
line in about a minute, but did not recover its acid state for twenty minutes 
after the meals. This is also explained by the above theory; for when the 
saliva is excited, the quantity is so great compared with the mucus, that it soon 
overpowers it, and for the same reason it would be long in recovering its acidity 
after the meal was completed. 

But is mucus or are all mucous surfaces acid? for to establish this theory it 
was required to prove this. A four-month foetus was examined by Mr. Mar- 
shall, and it was found that a strong acid indication was given by the mucous 
membranes of the mouth, nose, anus, and vagina: these, of course, were unin- 
fluenced by the special secretions which vitiate the experiments in the living 
subject, and which frequently are alkaline, as the tears, &c. The lining mem- 
brane of the parotid duct in the sheep was examined, and was found likewise to 
be acid. 

Smoking a pipe in this case did not increase the flow of saliva — only three or 
four drops of fluid issued from the ducts during the experiment, which was 
strongly acid. The state of the mouth was examined, yet notwithstanding the 
alkaline state of the smoke, was found to be intensely acid, and the quantity of 
the mucus was increased. These experiments seem clearly to prove the acidity 
of mucus. 

Chemical composition. — The alkaline state was not owing to free ammonia, as 
Schultz asserted; for the fluid, when kept at a high temperature, did not lose its 
alkaline state: the distilled fluid was not alkaline, and the papers made blue did 
not recover their redness when exposed to heat. Potassa was not found in the 
fluid, so it depended probably on free soda. 

Sulphocyanogen. — This has been asserted to exist in the saliva by some, but 
denied by others. 

The tests used in the experiments of Messrs. Garrod and Marshall were the 
action of the per-salts of iron, or the production of sulphuretted hydrogen from 
the fluid. A sulphocyanide colours the per-salts of iron blood-red; but the ace- 
tates, formiates, and meconic acid do the s^ame. But it is found, that when a 
crystal of corrosive sublimate is added to the fluid, coloured by the sulphocya- 



160 Progress of the Medical Sciences. U^^Y 

nide, that the colour vanishes. This does not happen with the fluid reddened 
by the other substances. Heat also destroys the colour of the sulphocyanide 
for the time; not so with the others. 

A piece of pure zinc and sulphuric acid were put into a test-tube; the hydro- 
gen evolved gave no trace of sulphur to lead-paper for half an hour, but when a 
few drops of healthy saliva were added, the lead-paper became blackened im- 
mediately, and the sulphuretted hydrogen was also sensible to the nose. 

Great care is required in this experiment to procure the zinc very pure, as 
sulphur is generally contained in it, and will vitiate the experiment. But this 
might be owing to the albumen, which contains sulphur as an essential ingre- 
dient, or to a soluble sulphuret. To obviate this an alcoholic solution of saliva 
was made, which could not contain albumen, which also gave the indications of 
sulphur. It was not owing to a soluble sulphuret, for the alcoholic solution 
did not blacken lead-paper. Now the sulphuret of lead is black, but the sul- 
phocyanide is of a light yellow colour. 

If further proof were wanting of the presence of sulphocyanogen in the saliva, 
it was found that when the solution ceased to evolve sulphuretted hydrogen, 
then also it ceased to give the red colour with the per-salts of iron. As no 
potassa or ammonia was found in the saliva, the sulphocyanogen probably exists 
in it, as a sulphocyanide of soda. Mr. Garrod then alluded to the experiments 
of Dr. Davidson, on the absence of sulphocyanogen from the saliva in certain 
diseases, as pytalism, fevers, &c., and remarked, that during the time the man 
was under the influence of mercury the sulphocyanogen was almost entirely 
absent, becoming apparent only by concentration (but the pytalism in this case 
was slight), and it seemed to return as the pytalism abated; but the operation 
for the fistula prevented their continuing the experiments. The man was 
labouring under phthisis also, and perhaps this might reduce the quantity of 
sulphocyanogen in the saliva. 

The quantity of solid matter found in the saliva was 1.7 in 100, it is usually 
stated to be about 1. in 100; but this increase might be owing to albumen, 
which was distinctly indicated by means of heat and nitric acid. Albumen is 
not usually considered one of the constituents of healthy saliva. The quantity 
of saliva from the fistula was found to be from two to four drachms during a 
meal, but the man's appetite was not very good. The saliva was found to 
change a solution of starch, so that it no longer gave the blue colour with 
iodine. The alcoholic extract of the changed starch was found to have a 
slightly saccharine taste; so probably a part of the starch was converted into 
sugar, the rest being only converted into dextrine. 

Microscopic characters. — Under the microscope the saliva was found to con- 
sist of a clear fluid, containing epithelium scales, small granules, and also true 
salivary globules, about -^-^-^^ inch in diameter. A nucleus was distinctly visi- 
ble in each when a drop of sulphurous acid was added. This nucleus seems to 
be situated rather to one side of the globule. — Lancet, March 12, 1842. 

6. Observations on Parasitical growths on Jiving animals. By Dr. Busk, 
Esq., Surgeon to the Hospital Ship, Dreadnaught, &c. — The occurrence of para- 
sitical growths, or of organized productions, having a close analogy with some 
forms of cryptogamic vegetation, upon the surfaces or within the substance of 
living animals, and in many instances constituting the cause of disease, is a 
subject of considerable importance in pathology; and although it would be out 
of place in these pages to enter into the pathological relations of these affections, 
yet as the microscope has been the means by which the few facts as yet ascer- 
tained in this matter have been brought to light, it may not, perhaps, be deemed 
irrelevant to the object of the Microscopic Journal, to admit a short statement 
of what has been observed, and thus to bring into one point of view, and attract 
the attention of microscopists, to a probably not unfertile field of investigation. 

1. On the 28th of August, 1832, Mr. Owen read some notes before the Zoo- 
logical Society on the anatomy of the Flamingo, {Phcenicopterus ruber,) in the 



1842.] Anatomy and Physiology. 161 

lungs of which bird he found numerous tubercles and vomicae, the inner surface 
of which latter was covered with a greenish vegetable mould or macor. Mr. 
Owen presumed that the growths had taken place during the life of the animal, 
and thence concluded that internal parasites are not derived exclusively from the 
animal kingdom, but that there are Entophyta as well Entozoa.* 

2. In the year 1835 a disease to which silkworms are subject, known under 
the name of Muscardine, was first described by M. Bassi of Lodi, and M. Bal- 
samo, a botanist of Milan. They ascertained that this disease was owing to the 
growth, on or within the body of the caterpillar, of a cryptogamic vegetation. M. 
Audouin, in 1836 and 1837, in a paper entitled " Anatomical and Physiological 
Researches on the contagious disease which attacks silkworms, and which is 
designated under the name of Muscardine,^^-f described a series of experiments 
on the chrysalis of Bomyx Mori thus affected, and which he had received from 
M. Bassi. He was able to follow in detail the transformation of the fatty tissue 
of the insect into radicles (thallus of the cryptogamic vegetation, to which he 
gave the name of Botrytis Bassiana.X 

3. The next observation is that of M. Des Longchamps,§ in a paper" On the 
habits of the Eider Duck {Anas mollissima),^'' in which he describes the occur- 
rence of layers oi mouldiness developed during life, on the internal surface of the 
aerial cavities of one of these birds, which he examined on the 2d July, 
1840, while yet warm. This vegetation occurred in the form of flakes or layers, 
deposited in great numbers on the walls of these cavities. Most of these plates, 
or layers, were circular, and they varied in size from two or three millimetres to 
several centimetres. The small bronchial tubes were covered with them in great 
abundance. Two kinds of these plates or flakes were observed. Beneath the 
larger ones the membrane upon which they were situated was uniformly redden- 
ed and thickened; beneath the smaller ones, towards the centre, a vascular net- 
work was seen, surrounded by a zone, in which the vascularity was less dis- 
tinct, and beyond this zone the vascularity was again increased, but in less 
degree than in the centre. The colour of the smaller flakes was a dirty white; 
the larger ones were also white, but greenish in the centre. The border of the 
larger flakes was irregular, which irregularity evidently resulted from their being 
formed hy the confluence of several adjoining smaller flakes. Examined under 
the microscope, this mouldiness appeared to be composed of transparent non- 
articulated filaments, slightly, if at all branched, and intermixed like the fibres 
of felt. These filaments, imbedded in a layer of albumen, were in parts scarcely 
the -gJ^y of a millimetre in diameter. M. D. further observed numerous ovoid 
or globular vesicles in the felt-like mass, of the same diameter as the filaments, 
which vesicles he looked upon as sporules. These growths appeared to have 
no immediate connection with the living tissue. 

4. A mouldiness of a diflferent kind was also observed by MM. Rousseau and 
Serrurier,|| which they describe as being found not unfrequently in pigeons and 
fowls, particularly in cold and humid situations, or in rainy seasons. These 
observers found it in the body of a male parroquet, which died of a tubercular 
disease, in a sort of false membrane between the intestines and vertebral column, 
which membrane was covered with a greenish pulverulent mouldiness, so light, 
and so little adherent, that it could be blown off as a fine powder. They further 
state, that a similar aflfection has been noticed by them in animals of other 
classes, as in Cervus Axis, and Testudo Indica, 

* Philosophical Magazine, 1833. New Series, vol. ii. p. 71. 

t Annalcs des Sciences Naturelles, vol. viii., new series, p. 229, pi. 10, 11. 

X For farther observations on this disease, vide a paper by M. Johanny, Annales des 
Sciences Naturelles, vol. ix. p. 65, 80; and one by M. Crivelli, in Schleclendahl's Lin- 
naea, 118, 123; and by M. Bonafous, L'Institut, clxxix. p. 154; and Henle's Patholo- 
gisch. Untersuchung. 

k Annales des Sciences Naturelles, June 1841, p. 371. 

II Comptes Rendus, 1841. 

14* 



162 Progress of the Medical Sciences. [J"ly 

5. In 1839, M. Schcenlein* announced the fact of the existence of My coder' 
mata in the crusts of Tinea Favosa. Priority, however, in this observation, is 
claimed by M. Remak,f who says that he made it as far back as 1836, when he 
stated that Tinea Favosa consisted of fungoid filaments.:}: 

On the announcement of Schoenlein's experiments in 1839, they were repeated 
by MM. Fuchs and Langenbeck at Gottingen, who supposed that they proved 
the existence of mucores, not only in the crusts of true Tinea, {Porrigo favosa 
and F. lupinosa,) but also in the majority of eruptions belonging to what they 
term cutaneous scrofula, for instance, in the crusts of Impetigo scrofulosa, and 
in those of serpiginous ulcers. These researches are published by M. Fuchs, 
in his Compte Rendu of the Polyclinique of Gottingen, in the Ann. Hanov. de M. 
Holscher, Cahier de 1840, and still later in the first volume of his Traite des 
maladies de la peau^ Gottingen, 1840. 

Latterly, however, a much fuller and more correct description of this disease 
has been given by M. Gruby, of Vienna,§ who states that the crusts of Tinea 
favosa contain, or in fact are made up of aggregated My coder mata. This growth 
consists of numerous corpuscles, rounded or oblong, the longitudinal diameter of 
which is from about the jToV^h, to the i^o^^ of a millim, and the transverse from 
the ^|o"th to the ilo^^. They are transparent, with a defined border, and smooth 
surface; colourless, or slightly yellow, and homogeneous. The corpuscles are 
either separate, or, by their apposition end to end, constitute beaded or articula- 
ted filaments, which are simply cylindrical or branched, according to the part of 
the crust in which they are found. Besides these beaded filaments, other much 
smaller branched filaments are to be observed, which are furnished at certain 
distances with partitions, (cloisons vegetales,) and thus represent oblong cells, 
in which are found very minute round, transparent molecules. Occasionally, 
some granules were found adherent to these filaments, similar to the spores of 
Torula olivacea, and T. sacchari.\\ The form of these filaments is considered by 
M. Gruby a sufficient proof of their vegetable character, and according to M. 
Brongniart, they belong to the group of Mycodermata. 

Each crust of Tinea is described by M. Gruby to consist of two envelopes, 
formed by the cuticle, and an aggregation of Mycodermata, which are inclosed 
within them like fruit in their pericarps. The crusts are placed on the surface 
of the true skin, and the Mycodermata are developed among the cells of the epi- 
dermis. 

The external disc of the capsule, which at the commencement is not perfora- 
ted, becomes open in the centre by a small hole, whose borders are elevated, by 
the continual development of the Mycodermata. This opening enlarges by 
degrees, and there is thus formed in the centre a whitish excavation, whilst the 
borders remain of a yellowish colour. Simultaneously with the enlargement of 
the opening, the Mycodermata protrude, and are developed like a fungus, and 
finally the borders disappear; the stems of the Mycodermata are prolonged, and 
the sporules shoot out vigorously, more in the centre than at the periphery. From 
this mode of growth, the form of the crust becomes quite altered, it being, when 
completely developed, convex, instead of concave on the outer surface. 

M. Gruby practised inoculation with the contents of these crusts upon thirty 
phanerogamous plants (but succeeded only once); on twenty-four silk-worms; 
four birds: eight mammals; and six reptiles, without any result. Similar inocu- 
lation in the arm of himself four times, and of another individual once, was 
followed also by no result, except in one instance, when a little inflammation 
ensued. Consequently, out of seventy-seven inoculations, one successful result 
only was obtained, and that on a phanerogamous plant— a strange fact, as is 
truly observed by M. Gruby. 

On the 1st of March 1841, Mr. Westwood exhibited at the Entomological 

* Mullet's Archives. 

t Medicinisch. Zeitung, No. xvi. pp. 73, 74. 

\ Valentin's Repertorium, 1841. § Comptes Rendus, 1841. 

II Icones fungorum hucusque cognitorum. A. C. J. Corda, Pragse, 1837, 1840. 



1842. J Anatomy and Physiology, 163 

Society, dried specimens of Chinese larvae, from the back of the neck of each 
of which a slender fungus, twice as large as the body of the insect, had been 
produced. The vegetation was stated to be analogous to some pn larvae from 
New Zealand, and is named Clavaria Entomorhiza.^ M. Corda gives the figure 
of a coleopterous insectf covered with Fenicillium Fieberi; and a similar instance 
of the growth of a minute conferva upon the body of a Dytiscus marginalis, oc- 
curred a short time since to my observation. This insect was kept in a glass 
vessel, in which were growing some plants of Valisneria spiralis, the leaves of 
which were much infested with the conferva. The beetle was killed, apparently 
by the growth of conferva among the branched hairs, with which its spiracula 
are furnished internally. it: 

These are the principal facts which I have been able to collect on this subject; 
for it is scarcely worth while to refer to the vague speculations of M. Meynier 
of Orleans, whose assertion of the analogy of warts and similar growths, with 
Fungi of the order Gymnospermia; of Lepra and Psoriasis with Lichens and 
Mosses; and of pulmonary tubercle with Lycoperdon, may, I think, justly be 
considered more the fruit of a heated imagination than of sure observation. The 
Mucores observed by Langenbeck in the body of a person dead of typhus, had 
certainly no connection with that disease: and as for the opinion, that hospital 
gangrene is dependent on the presence of a fungoid growth, I am unable to refer 
to the authority, upon which such a doubtful statement is founded. 

The above briefly recited facts are far too few in number, and not sufficiently 
precise, to allow of any general deductions of importance to be drawn from 
them; but it appears clear, 

1. That parasitical growths occur in nearly all classes of the animal kingdom. 

2. That these growths arise usually on the surfaces of animal organs, and are 
sometimes prolonged thence into the textures of the part. 

3. That they have in several instances been ascertained to constitute the cause 
of disease and death; and that the disease thus produced has been found in some 
cases to be contagious. 

4. That they are probably of two kinds, the one peculiar to animal bodies, 
and the other consisting of those cryptogamic vegetations, which readily sprout 
up under favourable circumstances, on almost any inanimate substance. 

To the former kind may be referred the Muse ardine oi the silk-worm and Myco- 
derm of Tinea; and to the latter, most of the other growths above alluded to.§ 

The vegetable nature of these growths does not in all cases appear so clear 
as might be supposed. In some of the instances cited above, there can be no 
doubt on the matter; but in others, and especially that of the Mycoderm, consti- 
tuting the crusts of Tinea, it is allowable to doubt whether the growth may not 
be more properly referred to the animal kingdom. In fact, it would appear, 
from the chemical constituents of these crusts, impossible to hesitate in ascrib- 
ing their contents to that division of animated nature; for according to the analy- 
sis of Thenard, they contained 

70 Albumen. 
17 Gelatine. 
5 Phosphate of Lime. 
8 Water and Loss. 

100 

* Annals of Natural History for November, 1841. 

t Pentatorna prasina, op. cit. Pi. xi. 

t [We are informed by Mr. J. T. Cooper, that he has frequently removed from the 
gills of gold fish, kept in a cistern in his garden, a quantity of confervse, the rapid 
growth of which over the whole surface of their bodies, in every instance caused 
death. — Editor.] 

§ With the exception of the parroquet, whose case is related by M. Rousseau and 
M. Serrurier, in which, in the account given by these observers, the seat of the para- 
sitic growth is by no means clearly defined, it would appear that these parasitic growths 
have nearly all had some relation to the air-passages, and in this point of view it is in- 
teresting to refer to the account of Chrysomyza Abietis, at p, 155 of this Journal. 



164 Progress of the Medical Sciences, U^^Y 

a composition certainly more animal than vegetable. With regard to this, also, 
it is interesting to refer to the paper of M. J. B. Desmazieres,* in which the 
genus Mycoderma, founded by Persoon in 1822, is for the first time accurately de- 
scribed and figured. He describes five species occurring in various vegetable infu- 
sions. The marked similarity of the figures of some of these species, with the 
Mycoderm of Tinea, is sufficiently curious, viz. those of M. glutinis farinulas 
and M. cerevisias, or those occurring in flour-paste or sour beer. M. D., whose 
paper is well vrorthy of perusal, considers, from his having observed the glo- 
bules of the Mycodermata occasionally in active motion, that they are of animal 
nature, and gives the following definition of the genus.- — Mycoderma. — Desmaz, 
Jinn. Sc. Nat. Tom. X. le Ser. p. 59. — " Animaleula monadina simplicissima, 
hyalina, gelatinosa, minutissima, praedita locomobilitate plusminusve manifesta; 
inter se ab uno extremo ad alterius extremum ordine longo cohserentia, sive in 
statu primordiali, sive post elongationem plus minusve notabilem; efFormantia, 
hac adjunctione fila inertia hyalina, creberrima, ramosa, moniliformia, vel dis- 
sepimentis conspicua, fere semper incumbentia liquoribus, vet substantiis humi- 
dis in quibus nascuntur et ubi, per eorum, implicationem, constituunt pelliculam 
plus minusve spissam. Generatio per gemmas interiores." 

The resemblance in figure, however, of this parasite to various growths, in all 
probability vegetable, is equally striking, if we do not consider that all growths 
composed of distinct rounded cells, whether of animal or vegetable nature, will 
necessarily much resemble each other. For instances of this resemblance, it is 
only necessary to refer generally to the plates in M. Corda's work,f and parti- 
cularly to the figures of Gonatorhodon speciosa; the extreme filaments of stysa- 
nus Caput Medusas; Torula tritici; Torula olivacea; Torula frutigena; and 
several others. 

The description of the Mycoderm of Tinea, by M. Gruby, above referred to, 
so accurately corresponds with the observations I have myself been enabled to 
make very lately, that I have thought the addition of a few figures of the ap- 
pearance presented by this parasitic growth under the microscope, would be 
sufficient to prove the truth of the position, that the disease does in reality con- 
sist of such a growth, and that this growth corresponds in every respect with 
the characters of Persoon's genus, Mycoderma. I have not, however, been able 
to perceive any movement in the globules themselves, as appears by M. Desma- 
zieres' observations, to have been the case in other species of this genus. There 
is, however^ always to be observed in the fluid with which the Mycodermata 
may be mixed, a great number of actively moving molecules or minute infusoria. 

This Mycoderm is readily seen by placing a fragment of a crust of Forrigo, 
moistened with water, between two glasses. The younger crusts present many 
of the small branched filaments and separate corpuscles; the larger crusts con- 
tain more of the beaded filaments, and in all, the Mycodermata are found mixed 
with epidermis scales. — Microscopic Journal^ December, 1841. 

7. Dentition of Children at the Breast, By Professor Trousseau. — Suspect- 
ing that the generally received ideas on the dentition of children were not cor- 
rect, M. Trousseau, from statistical observations not very numerous, has come to 
conclusions slightly different from the opinions generally believed. 

Period at which the first tooth appears. This has been determined in 25 
children; 13 boys, and 12 girls. It appeared as follows: 

In 2 boys at 3 months. In 1 girl at 3 months. 

2 at 4 2 at 3 

2 at 5 1 at 4 

2 at 6 1 at 5 

2 at 10 3 at 6 

* "Recherehes Microscopiques et Physiologiques sur le genus Mycoderme." — An- 
nales des Sciences Naturelles, torn. x. Ife. Ser. 1826. 

t Fracht-Flora Europgeischer Schimmelbildungen, Leipzig, 1839. 



1842.] Anatomy and Physiology. 165 

In 2 boys at 11 months. In 1 girl at 7 months. 

2 at 14 3 at 9 

1 at 14 

Extremes, 3 months, 14 months. 2 months, 14 months. 

Average, 7 months. 6 months. 

The average time, then, at which the first tooth appears is, from these results, 
six months and a half; while the generalbelief at present is, that at eight months 
it makes its appearance. The common opinion that little girls are more pre- 
cocious than boys, is also corroborated, as we find a difference of a month be- 
tween the appearance of the first tooth in boys and in girls. 

The first tooth is in general one of the middle inferior incisors. Of twenty- 
eight children this was the case in twenty-five. In two, a middle superior in- 
cisor appeared first; and in a little girl, the first molars preceded all the others. 

Period at which the second tooth appears. The twenty-five children in whom a 
middle inferior incisor first showed, had for their second tooth, the other middle 
inferior incisor. The common opinion is, that this second tooth appears almost at 
the same time as the first; and it is quite correct. In twenty-five children, the time 
that elapsed between the first and second tooth, was, 1 day in 4 children; 2 days 
in 2 children; 3 days in I child; 8 days in 3 children; 15 days in 7 children; 30 
days in one child; 90 days in 1 child. In six the time could not be determined 
by the mother. 

The middle superior incisors appear next after the two middle inferior. In 
eighteen children, fifteen had these teeth after the middle inferior incisors. The 
time that elapses generally between the cutting of the inferior and superior in- 
cisors, is more variable than is generally supposed. In thirteen children in 
whom M. Trousseau was able to verify this, there was a lapse of 8 days in 2 
children; 1 month in 3 children; 2 months in 3 children; 3 months in one child; 
4 months in 1 child; 5 months in 2 children; 10 months in 1 child. 

In general, then, there is a considerable interval between the appearance of 
the second first and the second second teeth. It maybe established as a general 
rule, almost without any exception, that after the appearance of these four teeth, 
the two lateral superior incisors next cut the gum, and then the two inferior ones, 
so that the child has only two teeth in the lower jaw, while it has four in the 
upper. It is curious, M. Trousseau says, that this fact, so well known to 
mothers who have brought up several children, should be unknown to those 
who have written specially on the subject. Whilst a considerable period takes 
place between the first appearance of the inferior and superior incisors, the four 
superior incisors follow each other at a short interval. After these six teeth 
have come through, some time elapses before the next, which are generally be- 
lieved to be the two lateral inferior incisors, appear. M. Trousseau, however, 
says, that as a general rule, one or several molars, and sometimes even the ca- 
nine, are protruded before them. After the cutting of the four molars, and the 
two inferior lateral incisors, another considerable interval of time elapses, when 
the four canine successively appear; and then after another period, at the age of 
from twenty-four to thirty months, rarely sooner, the second set of molars come 
out. 

In the second part of his work, M. Trousseau treats of the diseases incidental 
to teething, and especially of the diarrhosa accompanying it, and he combats the 
opinion so prevalent, that nothing ought to be done for it. He shows that it is 
not only not useful, but decidedly injurious to the little patients — that it weakens 
them, and lays the foundation of marasmus, which if not checked in time, soon 
goes on to a fatal termination. — Lond. and Edin, Monthly Journ, Med, Set,., May, 
1842, from Gaz. Med. de Paris, 4lh Feb, 1843, 



Progress of the Medical Sciences, U^^Y 



MATERIA MEDICA AND PHARMACY. 

8. Styptic effect of Kreasote. — A robust countryman divided the ulnar artery 
with a sharp knife, the consequence of which was repeated bleedings, which, 
however, were staunched by surgical aid. Three weeks afterwards, hemor- 
rhage returned, and Dr. Burdach of Luckan was sent for. He found the wound, 
which at first was a simple puncture, livid at the edges, and expanded to the 
size of the palm of the hand, by a spongy growth from the bottom. This spongy 
mass was in a gangrenous condition, and prevented the examination of the 
wound; the arm was swollen from the shoulder to the finger points; it could not 
be moved, and was excessively painful. Dr. Burdach had only the choice be- 
tween actual cautery and kreasote left, for in such a state of the arm, tying the 
artery was out of the question. He poured ^ss of kreasote {freed from eupion) 
into the wound. This gave the patient no pain; nay, after it he enjoyed refresh- 
ing sleep for the first time since the accident. There was no more hemorrhage; 
the pouring in of the kreasote was repeated morning and evening, and the spongy 
mass gradually diminished, and three days afterwards, under the co-operating 
influence of bandages moistened with kreasote, ol. tereb. and balsam, indie, 
loosened itself from the bottom of the wound. The divided artery was no more 
visible, the swelling of the arm decreased, and the complete cure shortly followed 
without any relapse. — Lond. and Edin. Monthly Journ. Med. Set. May 1842, from 
Medicinische Zeittmg, Jahrg. 1840. No. 31. 

9. Sulpho-Cyanuret of Potassium, — This salt, a most valuable re-agent for 
the salts of iron, has been recommended by Soemmering to replace in medicine 
the hydrocyanic acid and the cyanuret of potassium, the therapeutic properties 
of which it possesses without their inconveniences. M. Meillet employs the 
following plan for its preparation, which is cheaper than that in whicii alcohol 
is used. The mixture of dry prussiate of potass and sulphur is introduced into 
a Hessian crucible, and heated to the state of pasty fusion; it is then stirred with 
an iron rod, and withdrawn from the fire. When the crucible is cold, wash the 
mixture with water instead of alcohol, and filter; and a liquid, charged with the 
sulpho-cyanuret of potassium, and a little sulpho-cyanuret of iron, will be ob- 
tained. The iron is precipitated by means of the carbonate of potass, the fluid 
is poured off, and if it be alkaline, saturated with a little nitric acid. It is then 
evaporated and crystallised frequently; the acetate of potass remains in the 
mother waters. If the mixture be heated, as some authors advise, beyond pasty 
fusion, to a dull red, a large quantity of the sulpho-cyanuret of potassium is de- 
composed, and a notable quantity of carbonate of potass produced. It is better 
to have in the liquid a sulpho-cyanuret of iron, which can be changed into the 
sulpho-cyanuret of potassium, than potass, which is a real loss. If the fire has 
been too strong, and that is most frequently the case, in washing the matter with 
water we obtain a sulpho-cyanuret of potassium with the carbonate of potass. 
As boiling alkaline solutions decompose the sulpho-cyanuret into sulphuret of 
potassium, carbon which is deposited, and azote which is disengaged, the alco- 
hol was employed to isolate the carbonate insoluble in that menstruum. In that 
case it is advisable to add a few drops of v^hite pyroligneous acid to saturate 
the free alkali; the liquid is then evaporated, and set to crystallize. — Prov. Med. 
and Surg. Journ. May 14, 1842, (rota Journ. de Pharmacie. 

10. Lime Moxa. — Lime has been employed by Dr. Osborne as a moxa. 

It is used as follows: A little quicklime, to the depth of half an inch, is put 
within a porte moxa^ or a circular piece of card, and applied to the skin; water 
is then dropped on it, and mixed. In about two minutes it swells, and an in- 
tense heat is given out. It has been calculated that the heat produced is equal 
to 500° of Fahrenheit. If it is kept on as long as the heat continues, the whole 
skin is destroyed; but by removing it sooner, an issue to any extent may be 



1842.] Medical Pathology and Therapeutics, 167 

formed. Dr. 0. prefers this kind of moxa, from the great heat suddenly pro- 
duced, and from no fire or sparks being seen, so as to alarm the patient. To 
ascertain the depth to which this moxa acts, he applies it to the surface of an 
egg, and then observes the thickness of coagulated albumen formed beneath. 
The size of the ulcer formed is always twice as large as that of the lime applied. 
When the lime is prepared from calcareous spar, the heat produced on the addi- 
tion of the water is sudden and intense, and the pain is proportionately urgent. 
For ordinary purposes, however, well-selected pieces of lime, from a limekiln^^ 
answer well \i fresh, but not otherwise. — Lond. and Edin. Monthly Journ. Med, 
Sci., March, 1842. 



MEDICAL Px\THOLOGY, THERAPEUTICS, AND PRACTICAL 

MEDICINE. 

11. Five cases of Crowing Inspiration of Children in the same family. By 
Jonathan Toogood, Esq. — Case I. — H. I., when about a year old, was suddenly 
seized, without any previous indisposition, with the following symptoms: — A 
slight crowing noise was first observed, a feeble distressing cry was uttered, 
followed by a sudden suspension of breathing and threatening of instant suflfo- 
cation; the countenance became livid, the eyes starting from their sockets, frothy 
saliva was protruded from the mouth, the jaw fell, and he remained so long in 
this state that the bystanders thought he was dead. He was laid in a horizon- 
tal position and kept perfectly still, when, after a few minutes, a slight attempt 
at inspiration was made, which gradually improved, until his complete recovery 
was established. The contents of the bladder and rectum were evacuated 
during the attack; his countenance was very pale for a long time afterwards. 
During the next six months he had several slight attacks, which almost inva- 
riably commenced during comfortable easy sleep, and were preceded by an ex- 
pression of pain in the countenance, and, although of short duration, were very 
distressing. After this time they ceased entirely, and he has grown up to man- 
hood in the enjoyment of good health. 

Case II. — F. I., his brother, was attacked in the same manner when about 
six weeks old, and after repeated seizures, suddenly expired in one when four- 
teen weeks old. 

Case III. — 0. I., another brother, had a similar attack when about a year and 
a half old, but less violent. These recurred occasionally until he was three 
years old, when they ceased. He has grown up to manhood in good health. 

Case IV. — A. I., another brother, began to have the same affection when 
about six months old, which continued until he completed his fourth year. Dur- 
ing this period the attacks were sometimes so violent as to threaten instant 
death. They were occasioned by crying or passion, and once in consequence 
of a fall, which brought on so violent a seizure, that there appeared no proba- 
bility of his recovery. He was kept perfectly still, with his head a little 
raised, and after two or three minutes he began to breathe again. After this he 
had slight attacks on crying or losing his breath, but never a serious one; the 
countenance always became livid, and respiration was suspended, but there was 
no convulsion, which invariably happened when the attack w^as severe. 

Case V.— M. A., a sister, a delicate child, born at eight months, was very 
well until six months, when she was seized exactly as her brothers had been, 
without any previous indisposition. These attacks recurred frequently until the 
end of May, after which time she had slight ones. Convulsions, lividity of the 
countenance, and evacuation of the contents of the rectum and bladder, always 
accompanied the attacks. On one occasion she lay apparently dead, when the 
lungs were inflated, to which her recovery was attributed. In the month of 
June, when three quarters of a year old, the bones of the head, which had closed 
as firmly as usual at that period, except the interior fontanelle, separated again, 
and the division of the sutures could be easily traced with the finger. After 



168 Progress of the Medical Sciences, . [July 

this she appeared to get much better, and the spine, which seemed inclined to 
bend before, became strongs, and although she occasionally made a croupy noise, 
and had very slight attacks of lividity of the countenance, and temporary sus- 
pension of the breathing if she cried much, there was no severe symptom or con- 
vulsion. She continued pretty well until the 3rd of April following, and was a 
remarkably active, sprightly child, had eight teeth, and was then cutting the 
eye teeth. Whilst asleep in the garden she was suddenly attacked, as formerly, 
but soon recovered. This was supposed to arise from teething, and the gums 
were freely divided immediately. She now began to show symptoms of hoop- 
ing-cough, and was often unwell, making a slight croupy noise, which, however, 
did not appear to hurt her, as she often laughed before it was scarcely over. 
Her nurse thought it a trick. She appeared to be going through the disease 
favourably, but on Tuesday night did not sleep as well as usual, from more fre- 
quent fits of coughing, and was irritable the next day, scratching those about her 
on the slightest cause. On the following day (Wednesday) she had another 
slight attack. Her bowels having been carefully attended to, and the cough 
having been more troublesome during the night, some ipecacuanha wine was 
given at eleven o'clock on Thursday morning, which operated well. At one, 
whilst lying in the nurse's lap, she had a most violent attack, and was, for some 
time, believed to be dead, but after pouring an ounce and a half of brandy and 
water down her throat, she slowly, and with great difficulty, recovered. This 
was followed by convulsion and long continued spasm of the muscles, so that 
the body was quite rigid and could not be bent, although kept for a considerable 
time in a warm bath. She appeared to suffer great pain for two hours, after 
which she became easier, and remained so till seven o'clock, when the spasms 
returned with equal violence, and recurred every two minutes, affecting the right 
side chiefly, until five o'clock the next morning. No relief was obtained from 
the application of leeches, warm bath, the warm water injection, or lancing the 
gums. About eight o'clock she screamed violently, but she was sensible and 
took nourishment several times. At ten the spasms returned, butwith less vio- 
lence, but they continued with little variation during the whole of Friday and 
until Sunday morning, when she appeared to get somewhat easier, and although 
she was less drawn, and the dreadful grinding of the teeth had subsided, there 
was still a constant frowning and knitting of the brows, denoting great pain. 
She appeared sensible during the greater part of Sunday, took food occasionally, 
and slept a good deal, but it was doubtful whether she saw distinctly; there 
was no squinting. On Sunday night she became affected with spasmodic 
twitchings of the muscles, and was sometimes harassed with cough. She had 
a repetition of her former attacks at four in the morning, and again at ten, from 
which, however, she soon recovered. Another fit recurred at twelve o'clock, 
whilst lying perfectly quiet, in which she expired. 

The body was examined early on the following morning. It was not emacia- 
ted. Upon the removal of the pericranium, the skull-cap presented a natural 
appearance, the fontanelle not beiHg perfectly closed by ossification. It required 
more than the usual degree of force to tear off the skull-cap from the dura mater, 
and when this was effected, it was found that a large portion of the membrane 
adhered to the right parietal bone. The veins were turgid with blood. Between 
the arachnoid membrane and the pia mater, a substance of a gelatinous nature, 
rather hazy or milky in colour, was diffused nearly over the whole surface. 
Some fluid escaped from the surface of the brain, but the quantity could not be 
ascertained. Upon cutting into the lateral ventricles, they were found to be 
distended with fluid, as was also the communication between these and the 
third ventricle, which, as well as the iter ad infundibulum, and the iter a tertio 
ad quartum ventriculum, was also distended with fluid. There was also much 
fluid at the base of the brain and in the fourth ventricle. The whole quantity 
amounted to about four ounces. The substance of the brain was softer than 
natural. The viscera of the chest and abdomen were healthy. No glandular 
affection could be detected in any of these cases. — Prov. Med, and Surg. Journ.- 
May 7, 1842. 



1842.] Medical Patliology and Therapeutics, 16^ 

12. Case of enlarged Thymus Gland, producing spasm of Glottis hy compress- 
ing the recurrent Nerves. By Thomas Mitchell, M. D., of Dublin. — About 

4 o'clock A. M. 16th Deo. 1841, I was sent for to see the infant of Mr. , 

four months old, whom the messenger informed me was labouring under croup. 
On my arrival, I found the child lying across the nurse's knees, apparently much 
exhausted; the breathing quick and hurried, with a slight lividity of the face 
and lips; on making inquiry, I ascertained that the child had been in good 
health (if a slight diarrhoea be excepted), for some time previous, that about 
twelve o'clock at night, it appeared restless and uneasy, starting from its sleep, 
and crying, which was thought to be owing to the disturbed state of its bowels. 
Some carminative medicine was administered, and it fell asleep. 

About three o'clock, however, it awoke crying; the breathing became labo- 
rious, and hurried, attended with a peculiar shrill sound during inspiration, 
which gave rise to the opinion that it was croup; this symptom had disappeared 
before my arrival. 

As the only symptoms of urgency appeared to arise from the respiratory 
organs, I treated it as an attack of bronchitis, which at ihe time was very preva- 
lent amongst infants. It was put immediately into a warm bath, which pro- 
duced the most decided benefit, the difficulty of breathing was relieved, and it 
fell into a quiet sleep. I ordered a mercurial purgative to be given, and a mix- 
ture, containing tartar emetic, every 15 minutes, and after remaining some time, 
during which it appeared quite easy, I left the house expecting to find it much 
better on my next visit. Leeches were procured but were not applied. 

I had scarcely reached home when a messenger arrived to say that the child 
had had a well marked fit, the head was thrown back, the extremities extended 
and with the entire body convulsed, and on my arrival a second time it was 
dead. 

Dissection twenty hours after death. — Body fat, extremities stiff, considerable 
lividity of the posterior part of the body, and left side. 

On opening the thorax the anterior mediastinum v/as found completely filled 
with the thymus gland enormously enlarged, and distended, extending laterally 
over the lungs, (especially the right lung), which, with the right side of the 
heart were both engorged with blood, of a dark colour. On continuing the dis- 
section up the neck where the thymus ascends to meet with the thyroid body, 
the lobes on each side were greatly enlarged, each lobe completely surrounding 
the recurrent nerves, numerous large blood-vessels passed into it, and on making 
a section of it a quantity of dark serous like fluid escaped, which had the effect 
of greatly diminishing its size; the milky fluid described by some authors as 
being found in its centre was not present. 

The mouth, larynx, and trachea, were quite healthy in appearance, with the 
exception of a slight contraction of the rima glottidis, which in all probability 
had been much more constricted, and had become relaxed from the length of 
time the child had been dead. There was no appearance of disease in any 
other part of the body. The head was not opened. 

The cause of death in this case was so evident, that I think it would be use- 
less to make any comments upon it, neither am I aware that any method of 
treatment would have been of use. —Dublin Medical Fr ess, March 9, 1842. 

13. Identity of Cow-pox and Small-pox. — Dr. Muhry of Hanover, in a letter 
published in the Frov. Med. and Surg. Jour., 14th May 1842, states that Dr. 
Reiter of Bavaria, "variolated fifty coVs, and once succeeded in getting a pus- 
tule, the matter of which he employed on a child, and succeeded here likewise 
in producing pustules, but then, alarmed by a secondary eruption of vesicles, he 
took the disease for variola, and discontinued the propagation. The experi- 
ment was, however, as it were, accidentally continued, and afforded a most 
valuable proof of the identity. The cow which had produced the pustule stood 
in the same stable with another, and the latter about three weeks afterwards 
showed excellent cow-pox. The same happened, in another stable, and from 
both these infected cows children were inoculated, and showed very fine, well 
No. VII.— July, 1842. 15 



170 / Progress of the Medical Sciences. [July 

characterized cow-pox. This observation, though not taken as a proof by the 
author himself, is fully entitled to be added to the experiments of Thiele and 
Cely in favour of the question. 

He further states, that Dr. Gassnar, in 1801, inoculated eleven cows, one of 
which only became affected with cow-pox, and with the lymph from this cow 
Dr. G. inoculated four children of a clergyman, in all of whom a pustule was 
produced, having the characters of genuine cow-pox. The same occurred in 
seventeen other children, when he lost the lymph with the right time for its 
further propagation. 

14. Vaccination in France in 1840. — M. Gauthier de Claubry, in the annual 
report for 1840, states that the number of vaccinations amounted to 525,509 in 
836,789 births, or to five-eighths of the whole number born. Of 45,0G0 vacci- 
nations, the results of which were mentioned, 881 failed. In two cases, there 
was a general eruption of pustules over the body, the fluid from which produced 
regular vaccinia. 

Epidemic variola attacked 14,470 persons, of whom 1,668 died; in 24 cases 
small-pox occurred a second time, and three of those thus attacked died. The 
great majority of persons, whether recently or for a long time vaccinated, escaped 
epidemic small-pox; some had modified small-pox, which was generally mild 
and of short duration. Of 406 persons attacked after vaccination, only 6 died. 
Revaccination was performed in 2,214 cases; 1,704 failures; 227 false vaccinia; 
270 secondary cow-pox, apparently regular; 3 persons who had been successfully 
revaccinated were attacked with varioloid. The average cost of vaccinating 
each infant during the year 1840 was threepence halfpenny. 

The following are the conclusions of the report: — 

1. The regular vaccine is a preservative against small-pox; the protection,, 
however, is not absolute; for a small number of those vaccinated are subject to 
an eruption commonly known under the name of varioloid. 

2. The latter disease is generally mild, and free from danger; it destroys 1 
patient in 100, while the mortality of small-pox was 1 in 8^. 

3. A first vaccination destroys the tendency to a second attack of vaccinia as 
well as of small-pox; still, in some persons the aptitude to receive the disease 
returns after a longer or shorter period. Again, certain persons who have had 
small-pox may contract a regular vaccine, but this does not prove that they are 
apt to iiave small-pox again. 

4. The most perfect revaccination does not guarantee the individual against 
having a varioloid at some future time. 

5. In general, small-pox attacks persons only once; but some may have it a 
second time, and the second attack is just as severe as the first one. — Prov» 
Med. and Surg. Journ., May 14, 1842. 

15. Sciatica cured by Extract of Belladonna. — ^The following interesting case 
is related in the Bulletin Therapeutique. 

A lieutenant in the French navy had long laboured under a very severe form 
of sciatica; the pain extended from the sciatic notch to the terminal branches of 
the nerve in the foot, and was of the most violent kind. Several remedies had 
been tried without effect, when M. Hiriart resolved on employing the extract of 
belladonna. The bowels were first cleared out by an active purgative; and the 
whole limb was then rubbed, several times during the day, with an ointment 
composed of one part of the extract to two of lard. After the fourth friction the 
patient experienced a creeping sensation in the limb, and some slight symptoms 
of narcotism appeared; he enjoyed, however, some sleep during the night. On 
the following morning the pain had shifted to the opposite limb, whence it was 
driven by the same means. The state of the bowels and stomach was regulated 
by gentle purgatives and proper diet, and in a short time the patient was com- 
pletely cured of a disease from which he had previously suffered the most cruel 
torments. — Frov, Med. and Surg. Journ., March 26, 1842. 



1842.] Medical Pathology and Therapeutics. 171 

16. On the incipient stage of Cancerous Jlffections of the Womb. By Dr. W, 
F. Montgomery. — In this paper the author directs the attention of practitioners 
to a stage of cancer uteri which precedes the two usually described by writers. 

The symptoms are — sharp but comparatively fugitive lancinating pains in the 
back and loins, across the supra-pubic region, or shooting along the front of the 
thigh, or sometimes along the course of the sciatic nerve, producing numbness, 
and not unfrequently debility of the whole limb. 

In a large proportion of the cases, there is found a decided fulness, or a dis- 
tinct tumour in one or other iliac hollow, with fixed pain, and tenderness 
traceable to, and, as it were, issuing out of the abdominal ring; there is, gene- 
rally, more or less irritation of the bladder, with dysuria, and the patient often 
complains of a sensation about the lower part of the rectum, which induces her 
to think that she is labouring under piles. Menstruation, though in some in- 
stances disturbed, is much more frequently quite regular in its returns; but there 
is apt to be bursts of hemorrhage, either accompanying the discharge, or occur- 
ring in the intervals; there is little, or no leucorrhceal or serous discharge, often 
none; and it is not until the disease has existed for a considerable time, that the 
appetite is impaired, sleep is disturbed, the flesh becomes softer and wastes, and 
the countenance pale, and expressive of distress. 

On making examination />er vaginam^ the margin of the os uteri is found hard, 
and often slightly fissured, and projects more than usual, or is natural, into the 
vagina, and is irregular in its form. 

In the situation of the muciparous glands, there are felt several small, hard, 
and distinctly defined projections, almost like grains of shot, or gravel, under 
the mucous membrane. Pressure on these, with the point of the finger, gives 
pain, and the patient often complains that it makes her stomach feel sick. 

The cervix is, in most instances, slightly enlarged and harder than it ought 
to be. The circumference of the os uteri, especially between the projecting 
glandulse, feels turgid, and to the eye presents a deep crimson colour, while the 
projecting points have sometimes a bluish hue. 

There is no thickening, or other alteration of structure in any part of the 
vagina, at its conjunction with which the cervix uteri moves freely; nor is there 
any consolidation of the uterus with the neighbouring contents of the pelvis; in 
fact, the morbid organic change appears to be, at first, entirely confined to the 
OS uteri and lower portion of the cervix. 

This stage of the affection is, in many instances, very slow, lasting sometimes, 
for years, before the second and hopeless stage is established; during this time 
the patient experiences only comparatively slight and transient attacks of pain, 
or perhaps only sensations of uneasiness, referred often to the situation of one 
or other of the ovaries, or about the os uteri, with anomalous tingling along the 
front and inside of the thighs; these last for a few hours, or a day or two, and 
then disappear, perhaps for weeks; but again and again return in the same situ- 
ation, and for a long time are not increased in severity; the patient finds that 
sexual intercourse now, occasionally, causes her pain, which she ascribes to 
some deep-seated part being touched, and the act is followed by an appearance 
of blood; she is, also, often troubled with slight irritability of the bladder; but 
the appetite, digestion, and sleep, may, for a long time, continue good, and the 
pulse, generally, gives no indication of the existing disease, or its changes; an 
observation which will be found applicable to many uterine affections of a very 
grave character; in short, the general health may long remain quite undisturbed, 
nor has the patient, in many instances, the slightest suspicion that there is any- 
thing seriously wrong with her, nor thinks of seeking for medical aid, until she 
is induced to do so by the solicitations of her husband, or some anxious friend 
who lias become, as she thinks, unreasonably alarmed about her state. 

Dr. Montgomery thinks that the first discoverable change in the cases now 
alluded to "takes place in and around" the muciparous glandulae, which exist 
in such numbers in the " cervix and margin of the os uteri;" these become indu- 
rated by the disposition of scirrhous matter around them, and by the thickening 



172 Progress of the Medical Sciences, U^^Y 

of their coats, in consequence of which they feel, at first, almost like grains of 
shot or gravel under the mucous membrane. 

Treatment. — In almost every instance, the treatment should be begun by the 
local abstraction of blood, either by cupping, or by leeches applied directly to the 
OS uteri, or as near as possible to the organ; and their application will, in most 
cases, require to be frequently repeated, and should be accompanied by the free 
use of anodyne fomentations. Venesection is not, in general, required. Except 
there be something specially to forbid its use, mercury should be given, in some 
form, so as to bring the system very gently, but decidedly, under its influence; 
for which purpose it may be combined with iodine in very minute proportions, 
with camphor, opium, hyoscyamus, or hemlock; and occasionally by friction, 
especially where there exists evidence of inflammatory action in the iliac hol- 
low, as already adverted to. 

Afterwards, iodine or hydriodate of potash may be used both internally and 
externally; and iron will be found a most beneficial and powerful agent, espe- 
cially in the form of the saccharine carbonate, or the carbonate given in the nas- 
cent state. The iodide of iron, which combines, to a certain degree, the powers 
of both remedies, may also be used with some advantage in most cases. Coun- 
ter irritation is an agent of great influence in this complaint, and may be estab- 
lished in a variety of ways, which it is unnecessary to enumerate; but a very 
effectual mode is by making a small blister over different parts in succession, 
and keeping it discharging freely for several days, by the application of the 
French dressing, or Albespeyer's papers. 

After the removal of the congestion and organic changes from the os uteri, 
there remains, occasionally, a sensitiveness of the part, which causes the patient 
much discomfort, and which will be best relieved by the use of the bath, as 
above directed; conjoined with anodyne applications to the part, or the nitrate 
of silver in solution; the best mode of applying which, is by means of a bent 
glass tube of about an inch in diameter, which the patient can introduce and 
manage for herself; all that is necessary is, that she would lie on her back, and 
introduce the tube as far as its curvature, and then pour into the upper end the 
medicated solution, which will immediately pass to the os uteri, and can be 
retained there as long as is necessary, the tube filling the vagina sufficiently to 
prevent its flowing away, which Is a great advantage. 

The patient should be strictly enjoined to avoid everything that could stimu- 
late the uterus — such as riding on horseback, &c.; but, especially, she should 
refrain from indulgence in sexual intercourse. Wine, if used at all, should be 
of a very mild kind, and very sparingly taken; and the same rule should apply 
to malt drinks; the stronger kinds of ale and porter should be altogether pro- 
hibited. 

No circumstance connected with the treatment of this affection requires more 
scrupulous attention than the regulation of the patient's habits and mode of liv- 
ing; indeed, if this be not very carefully managed, all other measures will most 
probably be defeated. 

In illustration of the foregoing remarks. Dr. Montgomery relates several cases 
which terminated successfully under the treatment laid down by him. Further 
researches, however, are required to establish that the nature of the disease is 
truly cancerous. — Ibid., from Dub. Journ. Med. Sci. 

17. (Edema of the Glottis. — M. Bricheteau, in a memoir in the .Archives Gene- 
rales, (Nov. 1841,) endeavours to disprove the existence of this affection as a dis- 
tinct disease, unconnected with other affections of the larynx. M. Bricheteau 
criticises the facts adduced in Bayle's paper on the subject, and laments their in- 
completeness, as well as that of the cases which are found in the thesis of M. 
Thuillier. M. Bouillaud published three observations in the year 1825 tending to 
prove that this disease is in reality an inflammation of the larynx, pharynx, and 
surrounding parts. The remarks contained in the prize essay of MM. Trousseau 
and Belloc favour the same conclusion, which is further strengthened by the three 
cases detailed by the present author. Two of these cases terminated in reco- 



1842.] Medical Pathology and Therapeutics, 173 

very, but in the third the patient sank after the performance of tracheotomy. 
Some disease of the larynx existed in all three instances, to which cedema of 
the glottis succeeded. 

This cedema, which, strictly speaking, affects the lips of the glottis, not the 
glottis itself, is always a very serious affection, on account of the seat which it 
occupies. It cannot, however, be regarded as an idiopathic disease, and is itself 
more frequently an inflammatory affection or a purulent infiltration into the part 
than a serous effusion. It supervenes in the course of various diseases of the 
larynx, and should not occupy a different place in works on pathology from 
cedema of tumefaction or a part produced by any morbid poison, or from the 
various symptoms which attend syphilis, or from ulcerations of the intestines in 
fever.—i?. ^ F. Med. Rev. April, 1842. 

18. Complete obliteration of the Aorta. By Prof. Roemer, of Vienna. — An offi- 
cer, high in rank in the Austrian army, who had served during the war from 
1770 to 1815, and had always enjoyed good health till his 45th year, went at 
that time to reside at Mayence. He then suffered frequently from dyspnoea 
and gastralgia, but did not apply for medical advice until he had had several 
attacks of threatened suffocation, and his stomach had refused to receive every 
kind of food. During a year he was treated homoeopathically, without benefit. 
Severe palpitations then came on, accompanied by cedema of the extremities. 
The continued use of bismuth and digitalis made the dyspnoea and vomiting 
almost entirely disappear, but the pulse continued rapid, vibrating, and full. 
As his decease approached, he was seized with hoarseness, and a small dry 
cough; and at last he expired suddenly, in his fiftieth year, while playing at 
whist. 

Post-mortem examination. — The contents of the cranium were healthy, with 
the exception of a softened and exsanguine state of the brain, and ossification of 
the basilar artery. Four ounces of serum were found at the base of the skull. 
The heart was considerably hypertrophied; the valves were healthy. The aorta, 
as far as the origin of the arteria innominata, was much dilated, which latter 
was almost twice its normal size. The subclavians and the left carotid artery 
did not appear unnaturally large. The coronary arteries were ossified to the 
extent of about three inches. From the origin of the arteria innominata, to the 
point where the ductus arteriosus enters, the aorta became gradually smaller, 
and at this latter spot the diameter did not exceed half an inch; it was there 
found obliterated to the same extent; its thoracic and abdominal portion was 
hardly as large as that of a child ten or twelve years old; the walls of these ves- 
sels were evidently thickened. The intercostal arteries, which arose below the 
obliteration, had nearly the diameter of a quarter of an inch, and communicated 
freely between the third and fourth ribs, with the mammary and thoracic arte- 
ries. It was by means of these anastomoses that the collateral circulation was 
established; the pulmonary arteries were greatly dilated; the left laryngeal re- 
current nerve was greatly stretched, and the turn which it makes round the aorta 
corresponded to the obliterated point of that vessel. Biliary calculi were found 
in the gall-bladder. The lungs and other organs were healthy. — Lond» and 
Edin. Monthly Journ., April, 1842, from Archives Gen., Dec. 1841. 

19. Typhoid fever in the Foetus. — Dr. Manzini has written to the Academy 
of Sciences of France, that he has found the alterations of the intestinal follicles 
characteristic of typhoid fever, in the body of a seven months' child, who died 
20 or 30 minutes after birth. Many physicians witnessed the autopsy, and can 
testify, he adds, to the truth of his statement.— G«z. Med. de Paris, Dec. 4, 1841. 

20. Tincture of Catechu in fissure of the Nipple. — A writer in the Lancet, 30th 
April, 1842, states that he has found the tincture of catechu applied twice a day 
with a camel's hair pencil, very efficacious in that troublesome affection, fissure 
of the nipple. In one case, he states, the nipple which had been intolerably pain- 
ful for weeks, and was denuded, returned to its natural state within a day or two, 

15* 



174 Progress of the Medical Sciences. [July 

and the mother, who was about to wean her child in despair, was able to suckle 
it for more than twelve months without any inconvenience. 

21 . Cases of unexpected recovery from large Mscesses in the Lungs. — Dr. Graves 
has published six cases of abscesses in the lungs, which occurred in his own 
practice and that of his friends, in which complete recovery took place. The 
abscesses were situated both in the upper and lower part of the lungs, and were 
pneumonic, as proved in several of them by the excessive fetor of the expecto- 
ration, although the history of the case in some would have led (as, in fact, it 
did,) the medical attendant to suppose that they were cases of phthisis. He has 
given them to the public, to show "that patients may recover, contrary to the 
usual interpretation of the most significant and decisive stethoscopic symptoms, 
and therefore seem to merit publication, in order to warn practitioners from rely- 
ing too exclusively upon physical phenomena, and too hastily concluding that 
pulmonary lesions, however extensive, thus indicated, must necessarily prove 
fatal." They show, also, " that real circumscribed abscess occurs more fre- 
quently in the pulmonary tissue than Laennec allowed, or his followers seem 
to believe." The two following cases which we shall give, were under the care 
of Dr. Stokes, whose name is a sufficient guarantee for the accuracy of the phy- 
sical signs observed. 

Case 1. Mr. H., a gentleman aged about 22, was attacked with pain in the 
side, cough, and fever, and in a short time with very copious purulent expecto- 
ration. Soon after this, the signs of extensive abscess made their appearance 
in the antero-superior and lateral posterior regions of the lung. The patient 
was then considered to labour under tubercular caverns to a great extent. 
Shortly after Dr. S. saw him, he presented the following symptoms: — The 
whole antero-superior, lateral, and posterior upper part of the left lung, sounded 
extremely dull; perfectly distinct cavernous breathing, with large gurgling and 
pectoriloquy were heard from the second rib down to the mamma; and the same 
phenomena were audible along the fold of the pectoral muscle, from the 
axilla to the seventh rib. The expectoration was copious, muco-puriform, but 
not fetid, and the pulse full, regular, and under 90°. The treatment adopted 
was palliative. The pulse soon became natural, all hectic fever ceased, the 
dulness of sound on percussion was gradually diminished, and the patient, in 
the course of some months, was perfectly restored to health, all the signs of 
caverns having completely disappeared. 

2. Mr. D., aged about 25, high shouldered, and with a remarkable stoop, was 
attacked with cough in the autumn of 1839. His pulse became quick, he lost 
flesh rapidly, and presented the usual constitutional symptoms of phthisis in an 
early stage. Within a few weeks of the invasion of the disease, Mr. D. began 
to expectorate from half an ounce to an ounce daily of a sanious purulent matter, 
having the colour of urine, but not offensive. He soon after came to town. The 
right clavicle was dull on percussion, and the vesicular murmur feeble as far as 
the third rib. Above the clavicle, most distinct gargouillement existed; and the 
same could be heard in the acromial region, particularly when he coughed. 
Soon after this the pulse became quiet, and the expectoration, though still pos- 
sessing the above character, diminished in quantity. The patient went to the 
Cove of Cork, where he remained for the greater part of the winter season. He 
returned in spring, having become very fat, and without the slightest symptom 
or physical sign of any pulmonary disease. 

Dr. G. could have added several other instances, besides the six he has pub- 
lished, of pulmonic abscesses which have been cured; but he thought it unne- 
cessary, as those he has given were amply sufficient to show that they are nei- 
ther so rare nor so hopeless as they are generally believed to be. — Edin, and 
Lond. Monthly Journ, Med. Set., March, 1842, from Dublin Journal for January, 
1842. 

22. Sympathetic Pruritus. — Mr. Walter C. Dendy, in a paper read before the 
Medical Society of London, relates the following interesting example of Sym- 
pathetic Pruritus, 



1842.] Medical Pathology and Therapeutics, 17S 

I was requested to see a young married lady in consequence of a severe and 
most distressing cutaneous disease, which was not only the source of constant 
disquiet during the day, but which deprived her of sleep during the whole night. 
I was aware that about the sixth or seventh month of her late pregnancy (her 
infant being at this time some months-old), a most distressing cutaneous irrita- 
tion had then supervened, which was the source of many sleepless nights, and 
increased until it w^as apparently the cause of, and terminated in, premature 
confinement. From this she had rather a protracted convalescence, in conse- 
quence of free hemorrhage and exhaustion. In December last the pruritus re- 
curred with increased severity, and after two or three weeks I visited her in the 
country. Her suffering was at this time most acute, although to a certain degree 
remittent, and it was excited by comparatively trivial causes. There was, how- 
ever, somewhat of a regularity in its remissions, being the most severe about 
eight or nine o'clock in the evening: a sudden or loud noise would at any time 
produce it, when it seemed to resemble neuralgic pain, flitting from one part to 
another, or traversing the skin in lines. 

On examination, the skin over almost the whole body was studded with small, 
dark, bloody crusts, apparently from the abrasion of papulae or vesicles. This, 
hovsrever, was a fallacy. As 1 sat by the side of this lady during the greater 
part of an evening, I could immediately examine the seat of the pruritus or 
stinging, which was often instantaneous from a state of repose. 1 could not, 
however, discover on that portion of her skin (which was naturally peculiarly 
fair) the slightest morbid mark, papula, exanthem, vesicle, or weal. The nails 
were, however, instinctively applied to the part, and then a weal was observed, 
and soon after a bloody poipt from the abrasion of a papilla. 

It was clear that this was a morbid exaltation of the state of the papillary 
nerves, an error of innervation, as some would term it, or hyperasthenia of the 
skin from remote sympathy; but the primary functional derangement was not so 
clear. We know that changes in the spinal cord will give rise to hyperasthenia 
of the skin, and that depraved hepatic and renal secretions will alSo produce a 
variety of cutaneous derangements. In the former affection of this lady the 
condition of pregnancy was very judiciously judged to be the exciting cause by 
my very experienced friend, Mr. Martin, who attended her in her precarious 
confinement, as that gentleman found the pruritus gradually subside on her de- 
livery, the lochia, perhaps, in some degree, acting as a derivative. In a sub- 
sequent correspondence we agreed that a secondary affection of other organs 
was the immediate exciting cause. 

In November last and early in December the lady had been subject to ir- 
regular uterine discharges, yet there was a suspicion of early pregnancy; but 
she now asserted that she was much smaller in the abdomen, and therefore if 
the ovum were still in utero, it was probable that it was checked or blighted. 
The digestive functions were much deranged; there was no appetite; dyspepsia 
followed the swallowing of food; the evacuations were unhealthy; extreme 
languor and exhaustion ensued, and universal distress and prostration were ap- 
parent. On testing the urine, which was flaky, with litmus paper, it was in- 
stantly changed. The indications were to amend these secretions, especially 
that of the kidneys, leaving the uterine or remote causes to time, at the same 
time soothing the immediate paroxysms. Extract of colocynth and blue pill 
were occasionally given in small doses. Acetate of potass, tincture of hop, and 
syrup of marshmallow,were taken perseveringly three times in a day; of Dover's 
powder twelve grains each night at bedtime. The tepid-bath was* occasionally 
used; a strong decoction of poppies extensively employed in the evening on 
retiring to bed. 

In a fortnight, during which period the plan was most assiduously adopted, I 
found this lady improved in every respect; the appetite was restored; the urine 
and other secretions nearly healthy; the paroxysms of pruritus far less frequent; 
a great portion of the nights passed in sleep; the strength returning, and she was 
evidently gaining flesh. These amendments continued without relapse, and in 



176 Progress of the Medical Sciences, [July 

about three or four weeks a letter to me announced the lady's convalescence, and 
an unequivocal progress in her pregnancy. — Lancet, April 16, 1842. 

23. Suffocating Catarrh. — Mr. Robinson recommends closure of the patient's 
nostrils with the thumb and fore-finger during expiration, and leaving them free 
during inspiration, when a paroxysm of suffocating cough is present, and he 
says that in a very short time the patient will be relieved. He adds that he 
has adopted this plan whenever he had occasion so to do, and always with suc- 
cess. — Land. Med. Gaz, 

24. Cough from Spinal Irritation. — A lady had been under treatment for some 
time for violent fits of short convulsive nervous cough, which came on several 
times during the day. The paroxysm lasted, at each attack, eight or ten mi- 
nutes — in fact, till she was quite exhausted. She seemed otherwise in perfect 
health. There was no affection of the chest or larynx. She was about eight- 
and-twenty, married, of a very fine personal appearance. I begged to examine 
the spine: it was perfectly regular and straight; but on tapping the spinous pro- 
cesses of the vertebras hard with the end of my finger, percussion of the three 
middle dorsal spines caused her to shrink with a sense of inward soreness and 
pain. I slightly broke the skin at two places, half an inch to one side of the 
spinous processes of these vertebras (producing superficial sloughs,) by rubbing 
it with potassa fusa. In five days there was evident amendment. Twice in the 
fortnight the caustic was reapplied. The local soreness, and the cough in little 
more than this period had vanished. The surface broken at each point was an 
oval, half an inch by a quarter of an inch. — London Med. Gaz., February 4, 1842. 

25. Hiccup from Spinal Irritation. — A young lady, aged 19, was placed 
under my care for violent fits of hiccup, for which she had been under treatment 
ineffectually for two or three months. She was pale and delicate in appearance; 
but the want of colour was natural to her, and her constitution was good, and 
her health not otherwise disturbed; she was only thinner than usual, and weaker, 
and worn in spirits, from the frequent recurrence of the fits of hiccup, which 
supervened on any exertion or surprise, on the most trifling physical or mental 
excitement. I examined the back, which was perfectly straight; but I found 
that from about the fourth to the last dorsal vertebra, on tapping the spinous 
processes a sense of inward soreness was produced. I resorted to the same me- 
thod as in the last case, and in three months the patient had quite recovered. 
The hiccup had not been the only symptom: if the paroxysm was violent, it was 
sure to be accompanied with pain of the right side, and a thrilling sensation in 
the right ulnar nerve at the elbow, extending to the wrist and little finger. Fre- 
quent rests during the day in the recumbent posture, I found an important ac- 
cessory part of the treatment; with, towards the close, exercise to an extent 
short of fatigue, and tonic medicine. 

Three years afterwards (June, 1841,) this young lady came again under my 
care, for a return of the same complaint. It had been brought on by fatigue and 
anxiety: her father had died, and, in a few months afterwards, her mother. The 
hiccup was, in this attack, as troublesome as before in the former: there was the 
same pain in the right arm and right side; and a new feature, weakness of the 
right knee; and occasionally a short fit of coughing. The same inward soreness 
of the back was present. She recovered again under similar treatment; after 
which she went to Brighton, by my advice, and bathed frequently: she there 
completely regained her full health and strength. In both of these attacks, the 
local tenderness was throughout exactly commensurate with the tendency to 
hiccup, and lessened, decreasing in extent and intensity, as the hiccup les- 
sened." — Ibid. 

26. Jlsphyxia—the relative importance of warmth and cold to the surface. — The 
use of the warm-bath in all cases of asphyxia, seems to be a practice so gene- 
rally adopted that we must invite especial attention to the following remarks, 



1842.] Medical Pathology and Therapeutics. 177 

extracted from a paper by Mr. Snow, in the London Med. Gazette, (Nov. 5, 
1841.) 

"A consideration of great practical importance in the study of asphyxia is, 
the influence of the temperature of the medium in which it takes place. Dr. 
Edwards, of Paris, by a most extensive and beautiful set of experiments, has 
proved that throughout the animal kingdom, asphyxia is much more sudden at 
a high than at a low or moderate temperature; and that even cold-blooded ani- 
mals, which will linger for hours deprived of oxygen at a low temperature, will 
die as quickly as mammalia or birds in water at blood heat: even fishes will die 
in a few seconds, or at most two minutes, in water at 100° Fahrenheit, that has 
been deprived of its air by boiling, although this temperature would not injure 
them with sufficient air. He found that new-born mammiferous animals die 
most slowly in water at about 60 degrees, which is ordinary cold water, and 
that they die much more quickly as the water approaches blood heat. Dr. Ed- 
wards advises that persons in the state of suspended animation should, amongst 
other measures, be exposed to the cool air: and that the application of heat 
should be avoided, unless indeed just a momentary application, to endeavour to 
arouse sensibility. The Royal Humane Society, however, directs the applica- 
tion of warmth in all practicable ways, not only as an auxiliary to artificial 
respiration, but even to commence with, if the means for the latter are not in 
readiness; and most authors, I believe, coincide with the views of the Humane 
Society. Dr. Edwards considers it is by its effects on the nervous system, and 
through that on the heart, that a high temperature produces its effects. I think 
that, although the nervous system may be affected, and is probably the channel 
of its impression, yet that the deleterious effects of an elevated temperature, 
when respiration is stopped, depend on its stimulating the capillary circulation 
of the system, and thus promoting the de-oxygenation of the blood, that change 
which is antagonistic of respiration, which rules its extent under all circum- 
stances, and which, in fact, constitutes the necessity for having a respiration. 
But, whatever view we take of this point, the fact of the influence of tempera- 
ture on asphyxia proves that the application of heat ought to be avoided until 
respiration is thoroughly established, when it will, no doubt, be a useful auxili- 
ary to restore sensibility and renovate the patient. 

"The number of children that die of asphyxia at the time of birth is very 
considerable. Writers on midwifery have stated that one-twentieth of the chil- 
dren brought forth are still-born, and of these a large proportion are asphyxi- 
ated, from various causes, often at the very moment of birth. The first measures 
that are generally and very properly adopted, when a child is born in a state of 
suspended animation, are to admit the cool air to its skin, to dash a few drops 
of cold water on it, and use similar means to arouse sensibility, more especially 
that of the nerves of respiration. From the great vascularity and sensibility of 
the skin, and the thinness of the cuticle of new-born children, great benefit may 
be expected from the access of air to the surface of the body. Immersion in 
-warm water is sometimes had recourse to, and I have seen it completely suc- 
cessful in two or three instances, after the means just enumerated had failed; 
but this is a dangerous measure, one which, if it do not succeed, will quickly 
extinguish any possibility of recovery which may exist, as we have already 
seen. The great object in this, as in every case of asphyxia, is to establish 
respiration; and if the patient cannot be roused to perform natural breathing, 
artificial respiration must be had recourse to as quickly as possible. 

'•Several eminent authors on midwifery recommend breathing into the lungs 
of the child, if other means are not at hand; but not m-uch good can be expected 
from a measure which would undoubtedly suffocate a living child, and where 
there is any disposition to natural breathing, this will be decidedly injurious* 
Allen and Pepys found that air which had been once breathed, contained about 
8 per cent, of carbonic acid, and that if the same air were breathed over and 
over again, till suffocation was felt, it would contain but 10 per cent, of the 
same gas." 



178 Progress of the Medical Sciences, [J"ly 

27. Extensive Disease of the Pancreas. By James A. Wilson, M. D. — A gentle- 
man's servant, aged 41, of intemperate habits, unhealthy complexion, and 
distressed countenance, complained of constant pain at the epigastrium, some- 
times heightened to agony. He described it as " a pulling together of the pit of 
the stomach;" which he felt most when recumbent, and after food; and which 
was often accompanied by headache and giddiness. His pulse was regular, its 
beats 95 in the minute. In a month from this patient's admission into St. 
George's Hospital, and after an unusually long intermission, the pain suddenly 
and violently returned. Shivering succeeded; maniacal delirium, and death. 

After-death appearances. — A considerable layer of fat over the muscles of the 
abdomen. Pericardium unusually adherent to the heart, which was otherwise 
healthy. Lungs healthy. Brain softer than usual, and more vascular in its 
medullary substance. Some serous fluid on the arachnoid; very little in the 
ventricles. Stomach healthy. Spleen in a very soft state. Kidneys healthy. 

The President, (Dr. Williams) said, that the case which had been read was 
extremely rare and valuable: the symptoms marking it had been pain, vomiting, 
and severe headache, which were exactly those which he had observed lately in 
a patient who died from fungus haematodes of the pancreas. The pain and 
vomiting were easily accounted for; and the headache he had attributed to the 
great emaciation of the patient, and to the sympathy existing between the 
stomach and the brain. Dr. Wilson had attributed to the pancreas the office of 
merely diluting the bile; and, perhaps, this might be the fact, but it was not 
proved by the present case, because, although some calcareous matter was 
found in the duct, it did not follow that the secretions of the pancreas were en- 
tirely suspended, or incapable of permeating the mass: neither did it appear that 
the patient had suffered from any such affections of the bowels, as made a pro- 
minent feature in the case. The concretions, nevertheless, found in this case 
being similar to those found in the salivary ducts, seemed to point to the fact 
of the pancreas and salivary glands having a similar office, and was another in- 
stance of the truth of the physiological opinions at present entertained respecting 
the uses of that viscus. 

Mr. Ancell thought that there was so much contradiction in the physiological 
facts advanced with reference to the office of the pancreas, that no conclusion 
<eould be drawn from them. Thus, even as to the chemical composition of the 
|)ancreatie fluid, the German physiologists asserted that it was alkaline, while 
the French contended that it was acid. As great a contrast also existed as to 
the quantity of fluid secreted by the gland; for while Magendie had stated that 
it secreted only one drop of fluid in the half hour, other writers had said that 
the quantity secreted in that period was half an ounce. The pathology of the 
pancreas threw no further light on the subject, for there were no general facts to 
go upon. Thus, as a symptom of disease of this organ, vomiting was mention- 
ed as generally present; and one author had gone so far as to say, that if a 
patient suffered from vomiting and emaciation, without any other symptoms 
being present, he should consider that the pancreas was diseased. But how did 
this statement hold good when tested by facts'? Why, out of twenty-six cases 
of disease of the pancreas recorded by Dr. Abercrombie, there was no one urgent 
symptom in most of the cases to warrant the diagnosis that the pancreas was 
diseased. In many cases vomiting was present; in others there was only pain; 
in some there was pain and vomiting also. Vomiting, however, might be a 
mere accidental symptom, and he dependent on the involvement of the stomach 
in the disease. He thought, indeed, we had no fact which would lead us to 
determine that the pancreatic fluid was of any direct service in the process of 
digestion. He had no doubt, however, the organ had an important office to per- 
form, and he thought its function had a direct effect on the blood itself. 

Dr. Henry Lee had seen a case in which the chief symptoms were pain in the 
epigastrium and back, with emaciation and occasional vomiting: the patient was 
a long time ill, and at last died. After death the stomach was found to be per- 
forated at its posterior part by the head of the pancreas, which had become en- 
larged, and produced ulceration by pressure on the stomach. The edges of the 



1842.] Surgery. 179 

ulcer were red, and the structure of the pancreas was lobular. — Lancet, January 
22, 1842. 

28. Influence of venereal excesses in the production of Apoplexy. — Dr. Muynch 
has in many instances traced apoplectic attacks to venereal excesses. He sup- 
poses that they first augment the irritability of the brain, but, in consequence 
of their continuance, soon induce a state of permanent debility, and diminution 
of the tonic and cohesive power of the nervous system; and that the weakness 
caused by these seminal losses is of a much more severe nature, and more per- 
manent, than even repeated blood-lettings carried the length of producing cere- 
bral anasmia. 

The signs which precede the apoplectic attacks are in general loss of the 
intellectual faculties to a greater or lesser extent, loss of memory, incompetence 
for any continued mental exertion, in addition to the loss of the general health. 
Convulsive movements of the muscles of the arms and face are often remarked, 
and a state of mind approaching idiocy or insanity. 

When the apoplectic seizure is traceable to this cause, bleeding is highly in- 
jurious. The remedies recommended are quinine and other tonics, valerian, 
arnica, carbonate of ammonia, &c. together with frictions along the vertebral 
column with some stimulant liniment. — Ed. Med. and Surg. Journ. October, 
1841, from Annales de la Socieie de Med. de Gand. January, 1841. 



SURGICAL PATHOLOGY AND THERAPEUTICS AND OPERA- 
TIVE SURGERY. 

29. Treatment of Strangulated Hernia by Opium. — Attention has been recently 
drawn to this important subject, by Dr. D. Bell of Carlysle, Dr. A. W. Davis 
of Presteign, and Mr. George Cooper of Greenwich. 

Dr. Bell was led to the employment of morphia in cases of strangulated 
hernia, from having observed great prostration of strength and total relaxation of 
the system to ensue where considerable doses of that article had been given, and 
m i\\Q Lond. and Edin. Monthly Jour, of Med. Sci. for Sept. 1841, he relates 
three cases of strangulated hernia, in which he had resorted to the measure with 
entire success. 

Dr. Davis communicated to the Provincial Medical Association at their York 
meeting, a case of strangulated hernia, in which after the failure of all the 
usual means, a teaspoonful of laudanum, repeated at the end of two hours, was 
given; which caused almost immediately so much prostration of the muscular 
system that the hernia was easily reduced. The patient was a strong muscular 
man, a farmer's servant. 

Mr. Cooper relates, in the London Medical Gazette (18th Feb. 1842), the two 
following cases, equally successfully treated by the same method. 

John Brown, aged 50, with a large inguinal hernia, was seized with symp- 
toms of strangulation, on the 16th of November. Applied to Dr. Mitchell on 
the 18th, at whose request I saw him. The symptoms were most urgent; and 
having failed with the taxis, we proposed an operation, which he refused to sub- 
mit to. On the 19th, Mr. Busk saw him, and recommended me to try large 
doses of opium, as Mr. Bransby Cooper had informed him of a surgeon in So- 
mersetshire, who, for the last eighteen years, had so treated such cases. I im- 
mediately gave 4 grs. of opium, which relieved the pain and sickness, but pro- 
duced no change in the tumour. In four hours I repeated the opium, and five 
hours after gave a third dose of 4 grs. 20th. — Free from pain and sickness; the 
hernia in same state; he had occasional sickness, and a few doses of opium at 
intervals till the bowels acted, without any apparent alteration in the hernia, 
from which time he quickly recovered, and the hernia returned by degrees. 

Mrs. Woodhouse, aged 70, was taken with symptoms of strangulated hernia 
on the 22d of January, and sent to me on the 25th, She had a femoral hernia 
which I could not reduce; she is sure it was not present before the 22d, when 



180 Progress of the Medical Sciences. [July 

she had a violent fit of coughing-. I gave her two grs. of opium, with the 
effect of relieving the pain and sickness; five hours after, 2 grs. more opium. 
The following morning she said the hernia was gone, and she was quite well; 
there was no return of bad symptoms, but the bowels did not act till the 29th. 

30. Iodine Injections in the treatment of Serous Cysts. — M. Velpeau was in- 
duced, by the success which attended the use of this means in the treatment of 
hydrocele, to adopt it for various kinds of serous cysts, enlarged bursas, &c., 
about the knee, in the axilla, breast, neck, and other parts. The proceeding 
consists in puncturing the cyst with a trocar proportioned to its size, emptying 
it, and then injecting through the canula a mixture of one part of tincture of 
iodine with two parts of water. This having been retained for a few seconds, 
should then be nearly all drawn off again. The pain produced by this operation 
is generally inconsiderable, and ceases after a about a quarter of an hour; a day 
or two after reaction takes place the cyst inflames, though never severely; in 
two or three days more, resolution commences, the cyst diminishes, grows pale, 
shrivels, and in two, four, or six weeks the cure is perfected. It is rarely de- 
layed beyond this time, but it may be accelerated by rubbing the skin over the 
cyst with mercurial or iodine ointment when all the signs of acute inflammation 
in it have passed away. — British and Foreign Med. Rev., April 1842, from Bull. 
Gen. de Therap., Nov. 1841. 

31. Permanent closure of the jaws cured after a lapse of five years hy division of 
the masseter muscle. — Prof. Fergusson records in the Frov. Med. and Surg. 
Journ., (29ih Jan. 1842,) an interesting example of this. The subject of the case 
was a healthy man, 35 years of age, who was unable to open his mouth more 
than a quarter of an inch between the incisor teeth of the upper and- lower jaw; 
he was of course unable to masticate. This condition of things seemed to have 
resulted from an abscess which had probably formed in the substance of the 
lower end of the masseter muscle, and had left a tumour of the size of half a 
walnut. "The masseter muscle, though it had long been out of use, seemed 
of its usual development, and felt hard, as if in a state of temporary action. 
The other parts of the cheek seemed healthy, and the mucous membrane within 
was in a natural condition. The masseter of the opposite side felt somewhat 
flaccid, but otherwise in a healthy state." 

After trying iodine without benefit, Mr. F. determined to divide transversely 
either a portion of the masseter muscle, or its whole breadth. " I supposed that 
my wisest plan would be to try the effect of a partial division first, and I accord- 
ingly, with a very narrow blade, cut through about half an inch of the anterior 
margin of this muscle. The point of the knife was passed from the mouth 
through the mucous membrane and buccinator muscle, a little below the parotid 
duct, and having been pushed between the skin and the masseter, the fibres of 
the muscle were divided by carrying the edge from without inwards. Only a 
drop or two of blood followed the withdrawal of the knife; the divided fibres 
separated freely, and a very perceptible effect on the width of the mouth fol- 
lowed. After the lapse of fourteen days, being convinced that the benefit of this 
partial division of the muscle was likely to be permanent, I now resolved to cut 
through its entire breadth, and accordingly I did so by a proceeding nearly simi- 
lar to that already described, — the chief difference being that of pushing the 
point of the knife near to the posterior margin of the ramus of the jaw, so as to 
enable me to make a complete division of the muscle. The knife was blunt 
towards the heel, such as 1 use in dividing tendons and muscles in other parts 
of the body, so that the wound in the lining membrane of the mouth was not 
larger than the aperture made in pushing the blade onwards to the part to be 
divided. Having cut every fibre until the edge of the blade came in contact 
with the bone, I withdrew the instrument, when about an ounce of blood flowed 
from the wound in the mouth, and a considerable swelling occurred over the 
divided part of the muscle. The blood continued to trickle from the little orifice 
for some time, and always came more freely when the swelling was compressed. 



^1 



1842.] Surgery. 181 

At last it seemed to cease, and the patient left the house after having shown me 
that he could open his mouth to a greater extent than at any ti me (as he said) dur- 
ing the last five years. I did not continue the movements of the javi^ much at 
this time, as I observed that, whenever I did so, the swelling in the cheek in- 
creased, whilst there was greater difficulty and increased pain in subsequent 
attempts to open the mouth. 

" When I next saw him he informed me that, on his way home, the swelling 
in the situation of the wound increased to a very considerable extent, and the 
tension was so great that he could not move the jaw without considerable pain, 
when suddenly a stream of blood issued from the orifice in the mouth, and the 
tumour in the cheek rapidly diminished. Eight days after the operation, there 
was still some swelling from effused blood; in eight more it had nearly disap- 
peared, and the movements of the jaw could be made with less restraint and 
pain than formerly. More than a month after he had ceased in his attendance, 
he called upon me to show that he could open his mouth nearly as freely, and 
that he could now masticate his food as efficiently as he had ever done in his 
lifetime; all remains of effused blood had been absorbed; the original swelling 
at the lower part of the masseter was much as when I first examined it, and 
though he seemed delighted with the great improvement which had been effect- 
ed, there was still, as it appeared to me, such a degree of rigidity, that he could 
not gape to such an extent as, doubtless, he could have done in his earlier days. 
I recommended him to move the jaw freely and frequently, and, having since 
heard nothing more of the case, presume that the improvement has been perma- 
nent." 

[In the numbers of this Journal for Nov. 1831, p. 47 and 50, May 1S40, p. 88, 
and Aug. 1840, p. 510, will be found recorded, accounts of similar cases suc- 
cessfully treated.] 

32. Formation of an Artificial Jlnusfor the relief of Intestinal Obstruction. — This 
operation, originally proposed by Littre in 1720, and recently performed by M. 
Amussat, in six cases, in five of which it is reported to have been successful, 
was performed, in March last, by Mr. T. P. Teale, surgeon to the Leeds Gene- 
ral Infirmary The subject of the case was a woman, 54 years of age, labour- 
ing under intestinal obstruction from stricture of the sigmoid flexure of the colon, 
and an aperture was made in the descending colon, without opening the perito- 
neum. The patient died on the seventh day. The obstruction had been com- 
plete for ten days before the operation, and Mr. T. thinks that had this been had 
recourse to a few days earlier, the result would have been different. The case 
is related in fall in the Frov. Med. and Surg. Journ., March 19, 1842, 

33. Artificial Anus in lumbar region in an infant. — M. Amussat has performed 
this operation on an infant affected with congenital imperforation of the rectum. 
M. A. had tried to open the rectum through the anus, but was unable to find the 
gut; he then made an artificial opening in the left lumbar region, and the infant, 
now two months old, is well.— Gaz. des Hopitaux, No. 37. 

34. Rupture of the Spine, by a violent muscular effort. By M. Lasalle. — A 
man, thirty-six years old, was taken to the Maison Royale de Sante at Charenton, 
in a state of furious mania, and it was found necessary to confine him to his 
chair by means of two leather straps, which went from the upper part of its 
back and fixed his shoulders, and two others, which went from the same part a 
little lower down, and were fastened to his arms. After making various efforts 
to break from his confinement the patient rose up from his seat, threw his head 
forcibly backwards, and then flung it with great violence forwards. After this 
last movement the head remained bent on the neck, and the neck on the chest, 
and his limbs were completely paralyzed. The author saw him soon afterwards, 
and found an absolute loss of power in all the muscles below the neck, except 
the diaphragm, and those of the arms, which were but partially paralyzed. 

No. VII.— July, 1842. 16 



182 Progress of the Medical Sciences, [July 

There was neither bruise, nor swelling, nor deformity in the course of the verte- 
bral column. 

About thirty-six hours after these events, which were witnessed by a keeper 
and a fellow patient, the man died, with all the usual signs of pressure on the 
cervical portion of the cord. On examination, a solution of continuity was 
found between the fifth and sixth cervical vertebrae; the posterior cervical liga- 
ment and the interspinales muscles were ruptured, and no bond of union remain- 
ed between the spinous processes, whose bases were separated so as to expose 
the remains of the ligamentum subflavum and the membranes of the cord. The 
articular surfaces of the superior oblique processes of the sixth vertebra were 
also exposed, and its left transverse process was fractured. The inter-vertebral 
substance was torn; a part remained attached to the fifth, a part to the sixth 
vertebra; but there was no fracture of the bones, nor any material displacement 
of them. The dura mater at the ^at of the injury was tinged with blood, and 
the surrounding cellular tissue was infiltrated with it. None of the membranes 
were torn, but in the interior of the cord, opposite the injury, there was a vast 
ecchymosis, extending downwards to the second dorsal and upwards to the third 
cervical vertebra. — B. ^ F. Med, Rev, April 1842, from Gaz, Med, November 
27, 1841. 

35. Wound through the Sternum and arch of the Aorta. — By Dr. Caspar. 
The peculiarity of this unique case is, that the wound was made with a com- 
mon dinner-knife, only moderately sharp at its point and its edge, three and a 
half inches long, and three-fourths of an inch broad. With this a man stabbed 
his wife up to the hilt. She died in an instant; and the wound was found to 
have passed right through the upper part of the sternum into the arch of the 
aorta and the right lung. The bone was cleanly pierced, without any fracture 
or splintering. — Ibid, from Caspar'^s Wochenscrift, January 1, 1842. 

[The editor of the New York Medical Gazette states that an analogous case 
occurred in that city. The wound in this case was made with a common table- 
knife; it passed through the sternum without any fracture or splintering, and pene- 
trated the right auricle. Death was nearly instantaneous.^ 

36. Treatment of Ulcers between the Toes. — Dr. Schlesier says that an in- 
variably successful method of treating this affection, whether it have a syphi- 
litic origin or not, is to sprinkle them thickly day after day with red precipitate, 
and then to cover them with dry charpie. The cure is generally effected in a 
few days. — Ibid, from Med. Zeit, November 24, 1841. 

37. Successful amputation in spreading; Gangrene. — The propriety of amputat- 
ing in spreading gangrene being yet an unsettled question, every fact calculated 
to aid in its solution must be regarded with interest. We invite attention, there- 
fore, to the following case related by A. T. S. Dodd, Esq., surgeon to the Chi- 
chester Infirmary, related in the Prov. Med. and Surg. Journ, January 22, 1842. 

Charles Shotter, aged 33, a gentleman's coachman, had always been very 
healthy till about eighteen months since, when he had a severe attack of fever, 
since which he has never been hearty; was admitted to the Chichester Infirmary, 
March 14, 1833. His hand had been caught in a chaff-cutting machine, which 
sliced it through obliquely, a little below the back of the wrist joint, but not 
dividing the soft parts in the palm, and leaving the thumb and little finger entire, 
except some slight laceration of the skin; the carpal bones, and metacarpal, 
were cut through in the same oblique direction; the great artery of the thumb 
was uninjured, and only the arteria radialis indicts bled at all profusely, and this 
was accordingly tied. There had been some considerable hemorrhage before 
his arrival at the hospital, but not so much after he was admitted; indeed, as all 
the larger digital branches from the palmar arch were divided by the accident, 
I was surprised to find so few bleeding. 

As this was a simple case of incised wound without contusion, and as the 



1842.] Surgery. 183 

saving of a thumb and little finger would be a desirable object to my patient, I 
determined to try to do so in preference to amputating the hand, and I therefore 
turned back the integument of the palm, so as within a little to meet those of 
the back of the wrist, and kept them in their place by sutures and adhesive 
plaster. 

All things went on well till the fourth day, when violent inflammation took 
place at the wrist and forearm, which obliged me to take off the strappings. 
The report on the 22d of March is — There is a good deal of suppuration in the 
hand, and of inflammation up the arm; countenance distressed; pulse quick, 
weak, and irritable; stump looks pretty well, except that the granulations are 
flabby; there is a dark-coloured spot on the forepart of the arm above the 
wrist. 

23d. Had a comfortable night; pulse 100; inflammation of the arm rather 
less; suppuration free; countenance anxious; tongue brown; a large gangrenous 
vesicle upon the discoloured spot. 

In this stage of the case the question of amputation was not entertained, be- 
cause, the inflamed state of the forearm would not permit its performance to 
save the elbow, and I was unwilling to give up hopes of doing this, by subduing 
the inflammation which was the cause of the incipient gangrene. On the next 
day, however (24th), I found that the vesication had spread, and that the pecu- 
liar hard swelling accompanying gangrenous inflammation occupied the whole 
forearm, while emphysematous crepitus could be felt, even to about a third of 
the lower part of the upper arm. There was no line of demarcation in the 
skin; indeed the integuments of the whole limb about the lower third of the 
forearm were only inflamed, not gangrenous, though from the hardness, swell- 
ing, and emphysema, I could not doubt that the gangrene had spread along the 
cellular texture. The patient made little complaint; pulse 93; countenance 
much distressed. This being the state of the case, there was an immediate 
necessity for deciding the question, whether it was better to wait any longer in 
the hope of a line of demarcation taking place, or remove the limb at once, and 
trust to the hope of thus putting a stop to the destructive progress that was 
going on rapidly. With the consent of my colleagues I decided upon the lat- 
ter plan, and removed the limb at the middle of the upper arm by the circular 
operation. The only remark that I would make on the circumstances of the 
operation is, that in dividing the muscles, they retracted little or nothing, either 
at the time or afterwards; they were slightly dark-coloured, but otherwise all the 
part cut through had a perfectly healthy appearance. Not more than half a 
pint of blood was lost at the time of the operation. Three hours afterwards the 
patient was quite comfortable. From this time he went on extremely well, with 
the exception, first, that on the 28th the integuments of the stump underwent a 
smart attack of inflammation, which yielded to one application of leeches; and 
secondly, that for about three days after this, several sloughs of cellular texture 
passed into the dressings, leaving a large cavity, which, however, soon filled 
with granulations. These accidents of course retarded the case, blit he was 
discharged well on the 26th of April. 

Mr. Dodd is of opinion that in the selection of the place for amputating we 
should be guided by the emphysematous feeling, not the external appearances, 
" This proceeding," Mr. D. remarks, " demands an apparently great sacrifice of 
limb; but as it is an established general axiom in surgery to remove all the dis- 
ease, it is evident that if we are to consider the emphysema as a certain indica- 
tion of the disease in question in the cellular tissue, the only safe plan will be 
to remove the limb beyond the emphysema. I cannot help thinking that the 
very frequent ill-success which made such men as Pott and Thompson decide 
against amputating in spreading gangrene may possibly have arisen from taking 
the external appearances as the guide, instead of the state of the internal parts, 
to be discovered by the touch. 1 am aware that in a case of Mr. Lawrence's, 
he divided the parts about the shoulder-joint, which were full of emphysema, 
and the patient recovered: but this only shows what the powers of nature may 
occasionally do— not what we may safely expect of her; and if we have the 



184 Progress of the Medical Sciences, [July 

option of cutting beyond all feeling of crepitus, I conceive it will be right to do 
so for the sake of security, though, when we cannot even do this, Mr. Law- 
rence's case shows us that we need not despair, with a good constitution, of 
saving the life. The sloughs in my case were, I believe, the results of the attack 
of secondary inflammation of the stump, and therefore a mark only of the very 
irritable state of the system, not at all otherwise connected with the previous 
state of the limb." 

38. Reunion of the Fingers* — M. della Fanteria attended a young girl who 
had two fingers cut off by accident while engaged in domestic affairs. He 
found the fingers in some bran, in which they had fallen; but, to his great sur- 
prise, they were both cut into two pieces. He, nevertheless, determined to re- 
unite them to the hand, which he effected by strapping and sutures. At the 
end of a few days union was perfect, and the poor girl thoroughly recovered the 
free use of her fingers, the articular motions continuing.^!]) This case is verified 
by the celebrated Vacca, and by Professor Centofanti. — Frov. Med. and Surg. 
Journ. May 14, 1842, from Annali di Univ. di Med. 

39. Varicose crural vein. — An interesting case is recorded by Dr. de Castella, 
in the " Gazette Medicale^^'' of a lady's coachman, who presented the symptoms 
of strangulated hernia, under which he sank. He had previously positively 
asserted he never had a rupture, in which statement he was confirmed by the 
results of a careful examination of the rings. On examining the body. Dr. de 
Castella was exceedingly startled on perceiving a round, pyriform tumour, 
larger inferiorly than superiorly, occupying in the left groin the situation of 
crural hernia. It was about two inches long and one high, elastic, and of a 
brownish colour. He immediately proceeded to operate as for hernia, and the 
result was, that he discovered the tumour to be a varix of the crural vein, which 
was obliterated under Fallopius' ligament. There were several smaller va- 
rices in the internal part of the thigh and leg. The Doctor's alarm arose from his 
belief that he had mistaken a case of hernia. The cause of death was peritonitis, 
from cancer of the rectum. The varix may be distinguished from crural hernia 
by its shape, which is pyriform, or pedicular as it were, by its fluctuation and 
colour, and by the presence of other varices in the course of the crural vein. 
The hernia is globular, hard, and more closely applied to the crural arch. Petit 
mentions a case where a similar varix was mistaken for a hernia. — Ihid. 

40. Semi-amputation of the Uterus. — Dr. Grembler, of Neider Orschel, was 
suddenly summoned one morning to an hysterical female, aged 53, who had 
long been subject to procidentia uteri. On his arrival, he found her icy cold, 
and exceedingly pale. He ascertained that she had just removed with a knife 
that portion of the uterus which projected beyond the vulva, and that consider- 
able hemorrhage had followed. He arrested the bleeding by the use of the 
plug and styptics, and of appropriate internal treatment. That portion removed 
comprised nearly half the organ, including the os tineas. The patient soon got 
well, but her recovery was succeeded by hysteria and nymphomania. — Ibid, from 
Med, Zeitung. 

41. Introduction of Jlir into the Veins. — Dr. Godemer, Physician to the hos- 
pital of Ambrieres, in Mayenne, has published in the Transactions of the Medi- 
cal Society of Indre and Loire, three cases of tumour in the neck, during the 
amputation of which, a peculiar hissing noise was heard, followed by the instan- 
taneous death of the patient. The only abnormal appearance presented on the 
examination of the body, was the distension of the cavities of the heart by a 
great quantity of air. In removing large tumours from the neck, or from near 
the heart, we should avoid everything by which the entry of air into the veins 
can happen. Among these causes, M. Godemer classes the movements given 
to the tumour, in dividing the circumjacent cellular tissue, with the view of 
removing the diseased growth whole. To avoid this inconvenience, under these 



1842.] Surgery, 185 

circumstances, he removes the tumour piecemeal, and since he adopted that 
plan, he says he has not lost a single patient by this unfortunate occurrence. 
Six cases of tumour of the neck were operated on by him in 1839 and 1840, and 
with success. The patient suffers a little more pain; but in exchange, there is 
not any danger of the passage of air to the heart, and the consequent immediate 
death of the patient. — Ibid. 

42. Necrosis of the Os Calcis. — M. Mallespine, who has examined a great 
many cases of necrosis of the os calcis in children, states that, although gene- 
rally dependent on a constitutional cause, it remains a long while without affect- 
ing the other bones of the tarsus, and that, in general, the only operation needed 
is the extraction of the sequestrum, instead of the amputation of the leg. This 
latter operation, he says, is more frequently practised than needs be, because 
the tumefaction of the cellular tissue, which is sometimes enormous, the situa- 
tion of fistulous openings at a distance from the os calcis, and the lateral mo- 
bility of the foot (the result of the destruction of the os calcis, whereby the heel 
has lost all power of resistance), induce the practitioner to consider the disease 
more advanced and more extensive than it really is. He observes, further, that 
the absorption of the sequestrum takes place very rapidly, and that the new bone 
destined to supply the place of the diseased one, is deposited in the first in- 
stance on a level with the insertion of the tendo Achillis, and at the point cor- 
responding to the calcaneo-cuboid and astragalo-calcanoid articulations. The 
articular cartilages are not destroyed, and generally continue intact a long while; 
the ligamentous apparatus is generally found friable, softened, and thickened; 
occasionally, appearances have presented, as if nature were about to supply the 
place of the lost ligaments by a fresh apparatus. — Ihid. from Revue Medicale. 

43. Hypertrophied state of a fold of the Schneiderian membrane mistaken for 
nasal polypus. — A young woman was admitted into the Hotel-Dieu, of Cler- 
mont, for the removal of a nasal polypus, of which she presented all the symp- 
toms. A whitish round body filled up the nares, and a probe passed up by the 
side was stopped in its progress by its pedicle. Attempts were made to re- 
move it in the usual way by the forceps, but in vain, and each effort was fol- 
lowed by severe pain in the head; another examination was accordingly insti- 
tuted, when it was discovered that the supposed polypus was no other than an 
hypertrophied state of that fold of the Schneiderian membrane which covers the 
free edge of the inferior turbinated bone. It was removed with a pair of curved 
scissors without the loss of a drop of blood.. — Ibid, from Juurn. des Connass. 
Med, Chirurg. 

44. Van Gesscker'^s Bougies. — These consist of a strip of parchment rolled up so 
tightly that its layers adhere pretty firmly to one another, and they have at one 
end of it a knob or drop of glue, made of boiled parchment. This knob con- 
tributes very much to the facility of introducing the instrument into a stricture; 
one can feel it slipping in, and then, by the heat of the urethra, it melts, and 
the bougie unrolls of itself, while the melted glue is retained without injury to 
the urethra, and does not possess the slightest degree of any irritating quality. 
Such instruments may be manufactured of very small size, and yet possess suf- 
ficient strength; and their unrolling is rather advantageous than injurious, in 
cansequence of the slow dilatation to which the stricture is thus subjected. — 
B. and F. Med. Rev. April 1842, from Arntzenius on organic diseases of the 
urethra. 

45. Ventral Hernia. — A beggar, 42 years old, who had led a hard life from 
infancy, had a large abscess form at the umbilicus, which burst, gave vent to a 
great quantity of pus, and to a portion of epiploon, which, however, readily re- 
turned on his assuming the horizontal position. The wound cicatrised, but a 
hernia followed, and, as the man did not wear a truss, it increased in size, and 
the hernial opening was so large that the hand could be introduced into the ab- 

16* 



¥ 



186 Progress of the Medical Sciences, U^^Y 

domen. Some time afterwards a similar abscess formed on the external edge 
of the right rectus abdominis, followed by a hernia; and this again, in like 
manner, by an abscess and intestinal rupture on the left side. A year after- 
wards a fourth abscess formed below the umbilicus, which was succeeded by a 
hernia of the omentum, which adhered to the vicinal parts, and did not protrude. 
All this took place without the man leaving work or seeking medical assistance. 
One day in July last year, after a full repast, while ascending a staircase, he 
was seized with fainting and vomiting. On examination, it was found that the 
left ventral hernia had burst, and a portion of the ilium was protruded. M. 
Pellizo, who was sent for, succeeded in replacing the protruded gut, and cica- 
trisation took place without the occurrence of a single bad symptom. — Prov. 
Med. and Surg. Journ. May 7, 1842, from Annali Universali di Med. 

46. Amputation for diseased hone in Children, — M. Tavignot states, as the re- 
sults of his experience, that amputations ought not to be performed on children, 
as long as there is hope of preserving a limb, which may yet be of some ser- 
vice, unless the powers of life are endangered by colliquative diarrhoea. If the 
disease be more dangerous than the operation, then the latter should be had re- 
course to, and not otherwise. M. Tavignot denies the necessity of amputating, 
when the disease in the bone is entirely circumscribed, even if there be sequestra 
and fistulous canals, because either the original cause of the disease, the stru- 
mous cachexia, may disappear, and the disease with it, or, if it continue, an 
affection similar to that for which the operation was performed will be developed 
elsewhere. — Ibid, from La Clinique des Hopitaux des Enfans, 

47. Spontaneous Priapism during thirty hours^ with retention of Urine. By M. 
Demeaux. — A young man, twenty-two years of age, of a good constitution, and 
of a fair complexion, with a largely developed genital system, came to Paris in 
the month of September. He had been in the habit of indulging in sexual in- 
tercourse with moderation. On the night of the 10th, after no irregularity of 
diet, and after coitus, which was attended by an extraordinary degree of volup- 
tuousness, had been performed, the erection of the penis still continued, accom- 
panied with a burning sensation in the perineum, and along the course of the 
urethra. From time to time exacerbations took place, followed by a general 
spasm, during which there was a kind of emission. When M. Demeaux saw 
him at three in the morning, he found him much debilitated, with an anxious 
countenance, burning skin, bathed in perspiration, and a pulse 110, full and 
hard. The spasms and the emission still continued. The penis, much 
distended, and in contact with the belly, felt as hard as a piece of wood. 
The glans was of a purple colour, and the testicles, drawn towards the 
abdominal rings, were painful to the touch. The bulb was swollen, and 
formed a hard tumour about the size of a hen's egg; there were urgent but 
ineffectual efforts to pass urine. He was ordered to lie on a hair mattrass; to be 
bled to four palettes; to have a cold hip-bath; an enema with two grammes of 
camphor, and to keep a bladder of ice between his thighs. Five in the after- 
noon. The emissions had ceased since taking the cold bath, but the local symp- 
toms still the same; to have a draught with fifty centigrammes of camphor; fif- 
teen leeches to be applied to the perineum. Eleven in the evening. The spasms 
and emissions have returned; the bladder can be felt, forming a round tumour in 
the hypogastrium, and exceedingly painful on pressure. Leeches to be applied 
to the perineum, in such a manner as to keep up a continued loss of blood. At 
two in the morning, after sixty leeches had been applied, the penis became 
somewhat smaller. He was then placed in a hip-bath, at the temperature of the 
surrounding air, when he experienced indescribable relief. In about ten minutes 
he was able to make urine; he was taken from the bath, and immediately fell 
asleep. From this time all went on well, although the catheter had to be used 
several times. At the end of four days he was able to leave Paris, but his left 
testicle was still painful on pressure. — Monthly Journ. Med. Sci.^ May, 1842, 
from Gaz. Med. de Paris, February 4, 1842. 



1842.] Surgery. 187 

48. Berarcfs mode of applying the Vienna caustic for the cure of varicose veins, 
— M. Berard maintains that tlie peculiar mode in which he applies the caustic 
is of great importance in leading to success. 

In the first place, the point he selects for applying the caustic is below the 
knee, over the course of the vena saphena interna. This will generally be found 
sufficient to remove any varicose veins that may exist in the thigh; and even 
though ihey should not be removed, experience proves that they will cause no 
further inconvenience if the operation succeeds in respect to the leg; while any 
dangerous accidents after the application are much more likely to occur when it 
is used above the knee than below it. The obliteration of the vein at this point 
is usually sufficient to cause the disappearance of the other varices in the leg, 
though it may sometimes prove necessary afterwards to apply the caustic to one 
or two other veins, should they continue enlarged. In the next place, instead 
of making several successive applications of the caustic upon the same point, he 
applies it in sufficient quantity, or for a sufficient space of time, to burn at once 
down to the coats of the vessel. This will be effected by allowing a thin layer 
of the substance, brought to the consistence of a paste by the acid of alcohol, to 
remain on from a quarter of an hour to half an hour. Lastly, he produces a 
long cicatrix, instead of a circular one, by applying the paste for some way 
downwards along the course of the vessel. M. Berard states the advantages of 
the application used in the manner here prescribed to be, that it requires little 
or no suspension of the patient's ordinary occupations, that in general, one sin- 
gle operation will prove sufficient, that it is seidomer liable to be followed by 
serious accidents than the modes commonly in use, and that it hardly ever fails 
in effecting a permanent cure. — Ibid. 

49. Fracture of the neck of the Femur. — Mr. B. Cooper, in his recent course 
of lectures at the Royal College of Surgeons, attempted to show that fracture 
of the neck of the femur within the capsule never could occur; that, in fact, 
nature never intended that it should. He entered at considerable length into the 
arguments which had been adduced on both sides of this contested point, and 
denied that a case of osseous union of the neck of the thigh bone within the 
capsule, had ever occurred. — Lancet, March 19, 1842. 

50. Dislocation of the Sternum. — M. Maissoneuve presented to the Academy 
of Medicine of Paris, at their meeting of the 28th of March last, two prepara- 
tions taken from patients who had luxation of the first portion of the sternum 
on the second — a very rare accident. 

The first preparation was from a man aetat. 32, who fell from a height of 40 
feet on his neck. He survived six weeks. 

The second was from a man setat, 42, who fell from a height on his pelvis and 
was instantly killed. The lesion of the sternum was the same in both cases: 
the second portion was forced anterior of the upper, the periosteum in front was 
not lacerated. 

51 . Wounds of the Femoral vein in operations fur Aneurism. By Mr. Hadwen. 
— This is one of the most melancholy accidents which can happen, in the ope- 
rations on this artery; and it may occur in the hands of the most skilful opera- 
tor, as well as in those of the unskilful. There is scarcely an instance on record 
of the patient's recovery incases where the vein has been wounded. Mr. H. 
thinks that the fatal results are not owing to the wound of the vein, but to the 
ligature which is applied to the artery, including a part of the vein. He has 
seen the internal jugular wounded in an operation on the neck, where, although, 
the hemorrhage was great, yet it ceased immediately when the operation was 
finished, and the parts had regained their natural relations. He takes for grant- 
ed that simple wounds of veins, as a general rule, both superficial and deep, 
properly treated, are unattended by danger. It is quite unjustifiable, he thinks, 
to lie the artery at the place where the vein has been injured; and the practice 
that he would adopt in such a case is, to open the sheath of the vessels an inch 



188 Progress of the Medical Sciences, [}^^V 

above the injury of the vein, and tie the artery there, provided there should ap- 
pear sufficient room between the wound and the deep artery of the thigh, to jus- 
tify its application; if not, to go the same distance, or more, below. If the 
aneurism is in a state which admits ©f the necessary delay, it becomes an in- 
quiry, whether it might not be better practice to allow the wound entirely to heal 
before the artery is exposed a second time. The only recommendation this 
course appears to present is, the entire cessation of inflammatory action it would 
admit of in the vein, before the possibility of fresh disturbance could arise from 
the ligature. On the other hand, we must bear in mind the effect of a failure 
and second operation on the patient. These are circumstances, however, which 
each individual case and operation must determine. Future experience, he says, 
may decide whether the safest plan would be to pursue the treatment about to 
be mentioned; but at present, he is not prepared to give it unqualified recom- 
mendation. In a case of operation on this artery, at which he was present, and 
where the femoral vein was wounded, he urged that the ligature on the artery 
should only be allowed to remain a sufficient time to give the artery a fair chance 
of being obliterated, and then to remove it. His advice was adopted; and in a 
fortnight the wound was quite healed, and the patient in perfect health. It 
would be difficult, he says, perhaps impossible, to collect from a single instance, 
stronger support for the position he has assumed, than this case. — L. ^ E, 
Monthly Journ. of Med, Sci. from Lond, Med. Gaz., April 9, 1841. 

52, Polypi of the Rectum in Children. — Prof. Stolz has published in the 
Gazette Medicate of Strasbourg, a pamphlet on polypi of the rectum in children. 
This disease, he says, occurs from lime to time, and has almost never been 
taken notice of by any of those authors who have written on diseases of chil- 
dren, having been taken for a prolapsus of the gut. The case which first occur- 
red to him was in a boy five years old, and presented the following symptoms: — 
For eighteen months he had had frequent desire to go to stool; and for a year, 
at each time that he went, he had passed a red and bloody tumour, which is about 
five or ten minutes returned of itself. His parents, and several medical men 
who were consulted, believed that he laboured under a prolapsus of the rectum. 
Professor Stolz at first was of the same opinion, and various injections were ac- 
cordingly ordered. After several weeks, upon examining him minutely, he dis- 
covered, that it was not a prolapsus, but a tumour of the size of a small nut, 
and covered with a bloody mucus, which was protruded. It was attached not 
very high up the gut, by a pedicle of about the thickness of two millimetres, to 
the mucous membranes of the rectum. A ligature of silk was accordingly put 
round it and tied. In three days it came away; no bad symptoms followed, and 
the child, who had been in bad health previously, from loss of blood, soon re- 
covered his strength. Two other cases have occurred to the Professor since; 
and he has heard from his colleagues of several more. In one of the cases 
which he had, he removed the tumour by means of scissors. No blood follow- 
ed at the time; but in about two hours after there was copious hemorrhage, 
which put his patient's life in danger. The bleeding was arrested by compresses 
dipped in cold water, and by cold injections. The child soon made a good 
recovery, and soon regained his strength. 

This last case is another example of the danger of making any incision in the 
rectum, or even in its neighbourhood, without carefully plugging the wound 
afterwards. — L. ^ E. Monthly Journ. Med. Sci. February, 1842. 

53. Cases of double Hare-lip— period of life most suitable for operating for this 
deformity. — Mr. Houston communicated to the Surgical Society of Ireland two 
cases of hare-lip operated on by him at an early age, and made some interesting 
observations on the most suitable time of life for operation. 

Case I. Mary Fox, two years and a half old, the fourth child of a robust 
healthy mother, was admitted into the City of Dublin Hospital, June, 1841, for 
double hare-lip, and double fissure of the palate. The first child of this woman 
had been born with the same deformity; the second and third were well formed 



1842.] Surgery. 189 

at birth. The central piece of lip was large, a little inclined to the left side, and 
nearly the whole depth of the lip. The sides of the lateral fissures were con- 
tinued, inferiorly, nearly into each corner of the mouth, leaving very little infe- 
rior red border; superiorly, that of the right side was continuous in the nose 
with the fissure in the palate: that of the left did not enter into the nostril, al- 
though it approached within a line of it. The central piece of bone under the 
nose was very prominent, and contained two deformed incisors, one of which 
projected forwards, the other to the right side over the fissure between the bones. 
The nose was broad and flat; and the whole exhibited, especially when the 
child laughed or cried, a great and ugly gap — deformities which were observed 
by the mother to be growing more hideous every day. The infant had never 
been able to suck; and the act of swallowing had been always slow and im- 
perfect. It was, nevertheless, healthy and fat, and in every other respect well 
shaped. Mr. Houston then went on to say that, on the 7th of June, the opera- 
tion was proceeded with, in the presence of his coleagues. Professors Benson, 
Hargrave, and Williams, and Mr. Orr; the child being rolled up in a sheet to 
keep its arms and legs quiet, and placed sitting on the knee of an assistant. 
The lips of the fissure were first freely detached from the bones by an incision, 
with a scalpel, through the mucous membrane. The outer lamina of the pro- 
jecting bone, together with the protruding teeth, was then sliced off with nip- 
pers, so as to be rendered quite flat, and to afford a level support to the lip 
afterwards, but was not cut through in any part. Scissors were used to the lips, 
the angles being held by a tenaculum. The sides of the central piece were 
trimmed first, so as to leave it nearly the full breadth, and about two lines deep. 
The lateral borders were then excised, care being taken to cut well to the cor- 
ners of the mouth, so as thereby to remove completely the rounded angles, 
which are always present in such cases, at the junction between the vertical fis- 
sure and the natural, free red border. The needles used by Mr. Houston were 
two long, fine, wollen or darning needles, on which triangular points had been 
ground for the occasion. The lower, which was introduced first, brought the 
lateral pieces together with every exactitude, close above the free border; the 
upper one took in the central piece in its passage across from the one side to the 
other, and by its proximity to the nose, closed at the same time, completely, the 
fissure into the right nostril. The needles entered with much readiness, and, as 
one advantage resulting from their length, it was found unnecessary to pass a 
ligature on either until the fitting place and direction for both had been fully ap- 
proved of. The cheeks being now well pushed forward by an assistant, the in- 
cised surfaces, including those of the central piece, fell accurately together, and 
a very moderate pressure with a ligature, applied in the figure of 8 shape, was 
found effectual in keeping them so. 

The projecting ends of the needles were then nipped off, and their stumps 
covered with little rolls of adhesive plaster. The application of strips of 
plaster to support the cheek, and take off all drag from the needles, completed 
the operation. After the operation, the child fell asleep. During the succeed- 
ing days, there was slight feverishness, indicated by hot skin, restlessness, and 
loss of flesh; but the little patient continued throughout to take soft food, and 
nothing occurred to create any apprehension as to the completion of the union. 
In 72 hours the dressings and needles were removed; and, in order to render this 
operation the more easy, a light poultice had been laid over the whole, for 
about six hours previously. The union between the divided surfaces was found 
to be complete in every part, even so as to give a perfectly straight edge to the 
red border below; and superiorly, to close the left fissure a little way inside the 
nostril. The central piece lay on the same level with the lateral pieces, and 
had become united to them to its very point, from which down to the edge of the 
lip, there remained sufficient breadth of surface for firm adhesion of the lateral 
pieces at that place. 

Simple dressing was applied; and the newly established union carefully pro- 
tected against all lateral dragging of the cheeks by the use of adhesive plaster. 
The child partook abundantly of food, and, in less than a fortnight, left hospital 



190 Progress of the Medical Sciences, [J"ly 

— the incisions, the needle marks, and even the wounded gums inside being all 
most satisfactorily healed. The disfig'uring' breadth of the nose was also much 
reduced; and the mother had the great gratification of observing that solids, and 
even fluids, were swallowed without the least regurgitation through the nose. 

Case II., of which portraits were shown, was that of Maria Byrne, three 
months old, the first offspring of young and healthy parents, admitted into 
the City of Dublin Hospital, December, 1841. The fissure in the lip was in the 
left side and single, but so deep and wide that it entered the nostril at the top, 
and inferiorly ran to both angles of the mouth, leaving very little, free, red 
border to the lip. The palate bones were doubly cleft, and, in front, the right 
maxilla projected much over the left. 

The operation was performed by Mr. Houston, assisted by his colleagues, 
and Dr. Beatty. As the central piece of bone projected so far that the lips, even 
in their natural state, could not be drawn over it, its outer layer, together with 
the pulps of the teeth, were removed as in the former case, making a flat, even 
surface for the support of the future lip. The remaining steps were completed 
with the same scissors and needles, as above recommended, and the employment 
of them was found so far to facilitate the execution of the operation that all was 
finished in less than five minutes. The lower needle passed in such a situation 
and direction, that its point, in crossing from one incision to the other, filled up 
the open mouths of the coronary artery, and thereby stopped all bleeding from 
it. The upper took its hold so near the nose as to close the fissure in the nostril 
and secure adhesion in that direction. The crossing of the ends of the figure of 
8 ligatures held the central parts in proper and equable apposition. The infant 
appeared to suffer but little from the operation — a slight feverishness, such as 
occurred in the former case, was the only disturbance which followed. 

The needles were withdrawn at the expiration of sixty hours, and came away 
easily, having been loosened by suppuration. The adhesion was firm and accu- 
rately correct in every part. There was not a single point where freshly-cut 
surfaces had been brought into apposition, at which complete union had not taken 
place. On the very day on which the needles were removed, the infant' was 
seized with acute bronchitis, which lasted for three days, to the imminent risk 
of its life; nevertheless, the union held its ground, and after the subsidence of the 
attack, a healing action came over the needle holes, when all got rapidly well. 

Mr. Houston, in his observation on these cases, remarked that there was much 
difference of opinion regarding the most safe and befitting periods for under- 
taking such operations. Some think that the early months of life should not be 
selected, on account of the self-willedness of the infant— the softness of its 
tender flesh — its habitude of pressing the tongue against the lips as in the act 
of sucking — its want of power to bear a few days privation of food, and the un- 
importance to a young infant of the unsightliness of such a deformity:— such 
persons are still further of opinion, that at the expiration of three or four years, 
shame, and a feeling of its own infirmity would produce a desire on the part of 
the child to submit to operation; that, at this age, the tissues would have be- 
come suflSciently firm to bear needles or sutures; and that starvation for a few 
days would not so much endanger success. On the other hand, there are those 
who advocate an early operation on the following grounds: — That a grown-up 
child is more unmanageable than an infant; that its conduct is more influenced 
by fear of pain than by hopes of good from the operation; that the healing 
powers, so far from being more feeble, are more vigorous in the infant, than at a 
more advanced age; that the parts grow more naturally when early put-to-rights, 
than when permitted for a time to become mis-shapen; that the nose ceases to be 
so much spread out; that the fissure in the palate, if such exist, closes greatly if 
supported by a firm and perfect lip; that bad habits of speaking, such as nasal 
utterance, which, if once established becomes irremediable, are prevented; and, 
lastly, that the feelings of parents are especially gratified by having such de- 
formity repaired before their infant has gone abroad into the world. But, al- 
though the balance of advantages is thus evidently in favour of an early opera- 
tion, we have, nevertheless, so high authority as that of Sir Astley Cooper in 



1842.] , Surgery, 191 

favour of a delay, until the child has reached the age of two years. He fears 
convulsions at an earlier age. Velpeau selects the first six months of life; or, 
if that be passed, prefers waiting until the 10th or 15th year. Dupuytren's 
favourite period was the third month. Mr. Houston observed, that from the 
successful issue in the case of Byrne, at the age of three months, and from 
others to which he adverted as having been equally fortunate in his hands at the 
same age, he considered that to be the age at which, not only the greatest bene- 
fit may be done by operation, but that, also, at which there is as much exemption 
from fatality as at any other. The operation may, no doubt, be undertaken either 
earlier in life or later, if circumstances require it, and with more or less of benefit; 
but he regarded the third month as the most eligible period — particularly in 
cases where, as in the above, the infant cannot, from deficiency in the palate, 
take milk at the breast. Respecting the comparative advantages of the scissors 
or bistoury in such cases, the authorities for both are nearly balanced. 

Severinus and Louis among the ancients, with Listen among the moderns, 
recommend the knife: Desault, Dubois, and others are advocates for the scissors, 
whilst Le Dran, and B. Bell have recourse, indifferently, to one or other of these 
instruments. 

The advocates of the bistoury maintain that it produces less pain, and makes 
a neater wound, and one less disposed to suppurate; that the division of the flesh 
by scissors, being made more by a pressing than by a sawing motion, the latter 
consequence is the more likely to follow. Experience, however, does not verify 
the soundness of these views. Wishing to put the matter to the test, Bell ope- 
rated on one side with scissors, on the other side with a bistoury, without giving 
notice of the difference. The patient, when asked in which side he felt most 
pain, hesitated at first, and ended by saying that he felt most in that to which 
the bistoury had been applied. Mr. Houston stated that he has used both instru- 
ments, and gives the preference to the scissors. They require no support, but 
that given to the lip by stretching it from the angle: they remove in an instant, 
the precise amount required; their operation is not more painful than that of the 
knife; and, when sufficiently sharp and strong, they make a wound equally 
capable and certain, of union by the first intention. Regarding the amount of 
lip to be removed, the more usual error committed, is that on the side of de- 
ficiency. The rounded corners at the bottom of the fissure must be completely 
cleared away, as otherwise, no matter how perfect be the subsequent union, a 
depression will ever after remain to tell of the original malformation; nor need 
there be any apprehension about the danger of removing too much, for it is 
singular how yielding the lip is, and how much it grows in accommodation to 
its new condition. The drawings exhibited illustrated this point very satisfac- 
torily, — the free edge of the upper lip being, in both, straight, and admitting 
equally of perfect apposition with those of the lower lip. Mr. Houston observed 
that of the many hare-lips which, having at some former time been operated 
upon, met the eye in the streets, the upward dimple leaving a tooth or two ex- 
posed, was that which particularly attracted attention. 

The treatment to which the central piece in double hare-lip is to be subjected, 
must vary with its size and form. The plan adopted in the child Fox — a modi- 
fication of that recommended by M. Gensoul, as opposed to that of Louis and 
Heister, who operated only on one side at a time — succeeded perfectly, and with 
a smaller number of needles than are usually employed. A single needle was 
found sufficient to hold the central piece in its place; although Velpeau and 
others are in the habit of inserting, in addition to the large needles several 
smaller ones, called insect needles, or even of pinning the central tubercle to the 
bone underneath for the sake of greater security. But Mr. Houston is of opinion 
that all such extra needles are not only unnecessary, but prejudicial, as being 
calculated to irritate and inflame the already too tender flesh. The projecting 
piece of maxillary bone was treated as above described, viz., by paring off the 
outer lamina, and removing the teeth, because the deformity which, in both cases, 
it presented was such as could not be remedied by Desault's method of pushing 
it into place by a graduated pressure continued for some days or weeks. On the 



193 Progress of the Medical Sciences, [July 

subject of needles, Mr. Houston considered that the ordinary woollen needle 
possessed every requisite quality, more especially if pointed like the glover's 
needle. It may be had of any degree of fineness, and is of sufficient length 
after being deprived of its point and edge, to present a small polished surface to 
the flesh in which it is to lie. During the operation, too, it is particularly ma- 
nageable, as when once introduced there is little danger of its slipping out again, 
even though left untied, while the other steps of the operation are in progress; 
and that the presence of such is not a source of much irritation is shown by the 
length of time during which they lay comparatively harmlessly in the lip, viz.: 
seventy-two hours in the child of two and a half years, and sixty hours in that 
of three months — a duration which, by the way, may be perhaps as a general 
rule unnecessarily long, but which was permitted in the above cases for security 
sake, encouraged by the absence of all symptoms of inordinate irritation from 
their presence. 

Mr. Houston concluded by observing, that after all such operations, where 
great nicety and perfection is aimed at, the strictest precautions should be taken 
to guard against every source of inordinate feverish excitement; as under fever, 
the lymph thrown out is not organized, and failure must necessarily be the con- 
sequence. He considered that, had the bronchitis and fever which came on, 
on the day of the removal of the needles in Byrne's case, showed itself a day 
earlier, the operation would have been unsuccessful: and it is under the influence 
of such conviction that he is always desirous, especially in hospital practice, and 
when the patient is fresh from the country, of operating soon after admission, in 
order to have the wounds healed before there be time for any derangement of 
health from change of air, or other sources of insalubrity. 

Dr. Dawson, of Dungannon, has successfully operated for hare-lip upon a 
child four days old. The operation was performed on the 25th of January, and 
on the 12th of March the cicatrix was scarcely perceptible, and the sides of the 
fissures in the hard palate had become so much approximated together, that 
Dr. D. thinks by making raw the edges that he can cause adhesion between 
them. 

Mr. John Peebles reported a case operated on when the child was three weeks 
old. He "cut the edges with a sharp scissors, and united the cut surfaces with 
two long and fine worsted needles in the usual manner, and covered and sup- 
ported the parts with adhesive plaster: no bandage was required. In thirty-six 
hours I removed the upper needle, and on the third day the lower, as it was 
causing ulceration by its pressure, when I found the edges of the incision united. 
Cold cream spread upon lint and retained by two strips of adhesive plaster, ex- 
tending from ear to ear, completed the cure in a few days, which, in fact, was 
only delayed by the ulceration caused by the second needle." 

"The satisfactory termination of this case proves the advantage of an early 
operation. Very little blood flowed into the mouth; none was swallowed; the 
child only required four days spoon-feeding after the last needle was removed, 
or seven from the day of operation, and at the end of this time it took the breast 
freely." 

Mr. Porter has operated on a child ten days, Mr. Smyly one fourteen days 
old. 

In operating at an early age, it is important to guard against the little sufferer 
being allowed to suck after the operation, as a considerable amount of blood 
might thus be swallowed. — Dublin Medical Press, March 2, 23, and 30, and 
May 4th, 1842. 

54. Jlmputation during Pregnancy. — Mr. Tarleton, of Birmingham, relates 
in the London Medical Gazette, Dec. 17, 1841, the case of a female 27 years of 
age, labouring under necrosis of the tibia, and whose leg was amputated when 
four months advanced in pregnancy. No unpleasant symptom occurred, the 
wound healed, and she was in due time delivered of a fine boy. 



1842,] Surgery, 193 

55. Solution of Urinary Calculi. — M. Pelouse read to the Academy of Sci- 
ences of Paris, March 21st, a report in the name of M. Gay Lussac and himself, 
on various communications forwarded by M. Leroy d'Etioles on the subject of 
the solubility of urinary calculi. 

The author first drew atten'tion to the failures of empirical remedies, which 
have been abandoned one after the other; he then mentioned the proposal of 
Fourcroy and Vanquelin to suit the nature of the solvents employed to that of 
the calculous concretions; to attack uric acid calculi with alkalies, the phosphate 
and oxalate calculi with nitric and muriatic acid, and to inject these substances 
directly into the bladder. Latterly, it has been asserted, that the mucus which 
seems to bind or cement the calculous matter together is softened by the action 
of the alkaline carbonates, and thus a rapid solution or disintegration of uric acid 
calculi may be obtained. 

The experiments of the reporters were of two kinds; some made in the labo- 
ratory, others on the living subject. The chemical experiments proved that 
alkaline carbonates act rather on the mucus and animal matter, by which the 
particles of calculi are bound together, than on the calculi themselves. The 
degree of hardness and cohesion of the stone presents a much greater obstacle 
to its solution than its chemical composition. The alkaline carbonates act ex- 
tremely slowly on uric acid calculi, even when highly concentrated, and at a 
temperature of 104^ Fahr. When the calculus does not contain any carbonate, 
the solution proceeds infinitely more rapidly, though the agent employed is 
comparatively feeble. Experiments made at one of the mineral springs of Vichy 
furnished the same results, and, with a few exceptions, the solution was equally 
rapid in calculi of different kinds. A box divided into several compartments, 
and pierced with holes, was allowed to remain during two months in one of the 
springs at Vichy. Numerous fragments of calculi were placed in this box. All 
the fragments were diminished, and some of them remarkably so, but none were 
completely dissolved; indeed, although none of the original fragments weighed 
more than 180 grains, when taken from the box they were all much larger in 
diameter than the urethra. But, although the solution goes on very slowly in 
the waters of Vichy, it is more marked than the effects obtained by the alkaline 
carbonates or bicarbonates, and this seems to depend on the great quantity of 
carbonic acid contained in the Vichy waters, which acts mechanically on the 
calculi, and hastens their division. 

Numerous urinary calculi, and of various composition, were submitted during 
twelve months to a fluid containing from ten to twenty scruples of carbonate or 
bicarbonate of potass and soda to the quart of water, at the ordinary tempera- 
ture of the atmosphere. None of the calculi were dissolved, and some of theni 
appeared unchanged in size; the loss in weight varied from one-fourth to one- 
half of their original weight. Several fragments of calculi, weighing from five 
to ten scruples, and placed in a glass funnel, were submitted during three months 
to a constant current of water, containing one-twentieth of its weight of carbo- 
nate of soda. The size of the fragments was not diminished in an evident man- 
ner, but they were all more friable; the loss of weight varied from 0.10 to 0.60. 
Very small fragments of four to eighteen grains generally resist a saturated 
solution of carbonate of soda at a temperature of 86° to 104° Fahr. during 
a month; and the majority of calculi are so tenacious, that fragments not larger 
than a nut are not dissolved or disintegrated until they have been boiled for 
several days in water containing six scruples por quart of bicarbonate of soda. 

Instead of the carbonates, the borates of potass and soda, and nitric or muri- 
atic acids were employed, but with the same results; the borates, however, 
seemed to be somewhat more efficacious. 

The experiments now mentioned show how long and difficult a process it is 
to effect the solution of urinary calculi, even out of the bladder, and under the 
most favourable circumstances. 

The second series of experiments was made on patients, the majority of 
whom, previously to having undergone lithotrity, had tried for several months 
or even years, alkaline mineral waters or the bicarbonates. It is a matter of cer» 
No. VII.— July, 1842. 17 



194 Progress of the Medical Sciences. [July 

tainty that, in a great majority of cases, the use of alkaline remedies fails to 
effect the solution of urinary calculi; and those authors were probably deceived 
who announced the solution of large calculi in a few weeks or months under the 
influence of an alkaline treatment. 

M. Leroy not only regards the use of alkaline drinks and baths as generally 
inefficient for the cure of urinary calculi, but he thinks it a dangerous practice 
to force the kidneys to secrete alkaline urine during a considerable length of 
time. Many other practitioners, and amongst them M. Prunelle, inspector of 
the Vichy springs, are of the same opinion. He repeats the objection of Marcet 
and Prout, that the earthy phosphates held in solution by the free acids of the 
urine may be precipitated when the acids are neutralised, and thus give rise to 
the calculi containing the phosphate and carbonate of lime or magnesia. 

Cases of this kind occur in persons labouring under catarrh of the bladder, 
where the urine is altered in quality and retained in that organ: they do not occur 
under other circumstances, and the phosphatic diathesis seems to be an effect of 
the inflammatory affection of the bladder. The spontaneous changes which take 
place in the composition of urinary concretions may depend on the same cause; 
thus, when the urine becomes ammoniacal from inflammation of the bladder, the 
uric acid concretions are covered with a layer of a phosphate; and hence the 
great proportion of alternate calculi, which, according to Dr. Prout, form one- 
fourth of the whole number. M. Prunelle has seen patients who passed con- 
siderable quantities of uric acid gravel almost immediately after taking the 
alkaline waters; in some cases the quantity was such, that, if we suppose the 
gravel to have been formed in the kidneys, the latter must have been larger than 
the stomach. Perhaps the use of alkaline remedies occasions, in some patients, 
an abnormal secretion of uric acid, for we know that the presence of an alkali 
often gives rise to the formation of an acid. 

As the chemical experiments had demonstrated the great difficulty of dissolv- 
ing urinary calculi, it was thought prudent to confine the experiments made on 
the living subject to the fragments of stone which remained in the bladder after 
lithotrity. The alkaline carbonates and bicarbonates, the caustic alkalies, bo- 
rax, nitric and muriatic acids, dissolved in water, were injected into the bladder 
by means of a double syringe, and at a temperature of 95° to 104° Fahr.; from 
25 to 250 quarts of fluid were passed through the bladder of the same patient in 
this way. Some of the patients experienced no inconvenience from the injec- 
tions, but the majority suffered so much that it was found necessary to discon- 
tinue them. In one solitary case the calculous fragments were dissolved in a 
fluid containing from 0.04 to 0.05 of its weight of nitric acid; they were com- 
posed of phosphate of lime and the ammoniaco-magnesian phosphate mixed 
with a small quantity of uric acid. In several cases the cohesion of the calculi 
was considerably diminished. 250 quarts of fluid, containing fifteen scruples 
of the bicarbonate of soda to each quart, were passed through the bladder in one 
case; the organ was healthy, and the nature and volume of the calculous frag- 
ments had been previously ascertained; they underwent no diminution, but be- 
came so friable as to be crushed under the slightest pressure of the instrument. 
In most of the other experiments it was either necessary to suspend the injec- 
tions, or they produced no effect whatever on the volume or cohesion of the cal- 
culous fragments. 

Hence, M. Pelouse concludes that the attempt to dissolve urinary calculi by 
injection into the bladder, does not lead to any satisfactory result. Borax, and 
the other substances already mentioned, were equally inefiicacious. 

It has been recently announced in England that Benzoic acid, mixed with a 
small quantity of borax or alkaline carbonate, is converted into hipuric acid, 
which is found in the urine. The experiments made by the authors upon this 
point were not satisfactory; they were never able to detect the sliirhtest trace of 
hipuric acid in the urine. In many cases, however, they observed 'that the urine 
gave out an agreeable odour of alcohol, quite different from its characteristic 
smell, and remained for several days without undergoing any apparent change 
whatever. —Z^u^'/m Med. Fress, 20th April, 1842. 



1842.] Surgery. 195 

56. Cauterization of the neck of the Uterus. — During the last three months of 
the past year, M. Lisfranc has made a great number of experiments at the hos- 
pital of La Pitie, for the purpose of determining what is the best caustic that 
can be employed in cases where it may be necessary to cauterize the neck of the 
uterus. Simple ulcerations of this organ require the use of caustic, and it is 
now well ascertained that they are more or less rapidly healed by this means. 
Practitioners are equally in the habit of employing the nitrate of silver and the 
deuto-nitrate of mercury, but the circumstances which should guide us in the 
choice of either remedy have not been pointed out. From the numerous expe- 
riments instituted by M. Lisfranc, it would appear that hemorrhage very rarely 
ensues after the use of the deuto-nitrate, while lunar caustic frequently occasions 
more or less abundant loss of blood. H-ence it follows that, whenever ulceration 
of the neck of the uterus is accompanied, as it often is, by congestion or sub- 
inflammation of the organ, we must not employ the nitrate of silver, which has 
a tendency to increase the congestive state of the uterus. 

During the last three months of the year 1841,72 cauterizations were per- 
formed on eleven women affected with ulceration of the neck of the uterus: in 
44 of these operations, the nitrate of silver was used, and in 31, its employment 
was followed by a discharge of blood; on the other hand, the deuto-nitrate of 
mercury was used in 28 cases, and in 3 only occasioned a slight discharge. — 
Ibid, from Bull, de Therap. 

57. Tesico-vaginal Fistula. — M. Leroy d'EtioUes read to the Royal Academy 
of Medicine of Paris, March 8th, a memoir on vesico-vaginal fistulae. The 
cause of the failures attending operations for the cure of this affection are, the 
size of the opening, the diminished capacity of the bladder, the thinness of the 
vesico-vaginal septum, and the injurious action of the urine. 

When the fistula is small, it often heals up spontaneously; if a little larger, 
much benefit will be derived from the employment of the actual cautery, but the 
present mode of applying this remedy is faulty. The tumefaction of the edges 
of the fistula, caused by the cautery, closes the opening for a few days; but the 
cauterized parts soon come away, the tumefaction ceases, and the opening is 
re-established. M. Leroy proposes to apply the cautery at two different peri- 
ods; by the first application he would merely bring the edges of the fistula in 
contact; by the second he excites an adhesive inflammation in the parts. 

When the fistulous opening is large, the cautery fails, and we must have 
recourse to other means. As the chief obstacles are the thinness of the vesico- 
vaginal wall and the contact of urine, M. Leroy proposes to raise up the wall of 
the vagina, and apply it over the opening; this, however, can only be done when 
the fistula occupies the middle of the vesico-vaginal septum. 

For very large perforations, the only remedy seems to be an autoplastic ope- 
ration. The method of M. Jobert almost always fails, from mortification of the 
long flaps taken from the labia or thigh. The arched flap of M. Velpeau is 
obtained with great difficulty. The author proposes to take the flap from the 
posterior wall of the vagina; he commences his incision below the fourcheite^ 
divides the cellular tissue which unites the vagina to the rectum, and stops at 
the point where the union between the two walls becomes intimate; a short, 
wide, and thick flap is thus obtained and applied over the fistulous opening. 
Finally, there are cases which do not admit of being relieved by any operation 
whatever. In these unfortunate circumstances, the author proposes to plug the 
vagina with a layer of Indian rubber, which is free from the inconveniences 
attending all attempts at permanent plugging hitherto made. — Ibid. 

58. Hernia of the Stomach. — A woman, aged between 60 and 70, had three days 
before been taken with vomiting of a thick blackish liquor, which was thrown 
up in considerable quantities. She was cold, the vital forces depressed, the 
pulse weak and low. The tongue was black, with a thick moist fur. She had. 
had for many years an umbilical rupture, as large as a man's head. She had 
before experienced two attacks of the same kind, but less severe and serious. 



196 Progress of the Medical Sciences. [J"ly 

On examining the umbilical tumour, I found it in no degree tense, nor was it 
particularly tender or uneasy on being handled, but its contents I could not re- 
turn or lessen. The belly was soft, and in no degree sore on pressure. I 
viewed the case as one of haematemesis, and recommended astringents, with 
opium and stimulants. The patient died in twelve hours. K post-mortem dis- 
closed more than half the stomach, of three times the natural thickness, in the 
sac, together with omentum and colon. The neck of the sac was very large; the 
contents of the sac had not been strangulated; they were not in the least dis- 
coloured. There was an abrupt line at which the natural texture of the stomach 
terminated, and the thickened portion commenced; the latter must have been out 
of the abdomen for years. — Lond, Med. Gaz., Feb. 1842. 

59. Rare form of Internal Strangulation. — Prof. Geoghegan communicated 
to the Surgical Society of Ireland the following example of this. 

A female, aetat. about 40 years, was admitted March 23d, into the Adelaide 
Hospital, labouring under symptoms of alvine obstruction of three days' stand- 
ing, which had commenced by pain about the umbilicus, followed by bilious 
vomiting; in addition to the above symptoms, the following were noticed on 
admission: — Constipation, tense and tympanitic abdomen, which vyjas slightly 
tender a little above the umbilicus on the relaxation of pressure, anxious counte- 
nance, hiccup, and accelerated, yet firm pulse. A careful examination failed to 
detect any hernial protrusion. Notwithstanding the energetic employment of 
appropriate means, the symptoms continued to increase in intensity, (with tri- 
vial remissions.) the vomiting, previously bilious, assumed a stercoraceous cha- 
racter, both as to appearance and odour, and about forty-eight hours before death, 
obvious indications of peritonitis had supervened — the patient succumbed on the 
twelfth day of her illness. It appeared that about eight years previously, she 
had had an attack of a similar character, which persisted for five weeks^ and 
finally subsided under the employment of calomel and blisters. The treatment 
was directed to the removal of intestinal obstruction, and the prevention of 
inflammatory action, and consisted in the employment of injections administered 
with the long tube, purgatives, mercurials, &c. 

On dissection the cause of the mischief proved to be a constriction of the 
ileum, by the vermiform appendage of the coecum, which, together with a band 
of condensed fatty and cellular membrane derived from the posterior aspect of 
the latter intestine, had passed in front, and encircled it about two inches from 
its termination: the vermiform appendix was converted into a sort of ligamen- 
tous cord, and its cavity, except for about half an inch from its commencement, 
obliterated; having passed around the ileum, it terminated by attaching itself to 
a sac of a reddish black colour, of cylindrical form, and about the size of the 
gall-bladder. This sac was invested by peritoneum, except on its posterior 
surface, which was attached to the iliac fossa, its walls were thick and fibrous 
externally, internally lined by a smooth membrane, between which and the 
external tunic, there was at its upper part a laminated texture: there were also 
a few small patches of bony deposition on the inner surface — the cavity was 
filled by a dark red matter of the consistence of stiif jelly, and presented in its 
back part a small excavation opening on the iliac fascia, by an orifice in the 
fibrous investment of the sac — the intestinal tract above the stricture presented 
unequivocal marks of peritoneal inflammation, and was distended with flatus 
and fluid faeces, its mucous coat was also congested, and of a reddish gray 
colour, with some submucous infiltration — the strangulated portion of the ilium 
was coated with lymph, and its parietes considerably thickened, and at its termi- 
nation in the ccecum extremely brittle, the latter intestine was also partially 
coated with lymph; the colon contained a few scybala, and was uninflamed. 
As to the mode in which the vermiform appendage insinuated itself around the 
small intestine, it would be useless to speculate. Dr. G. observed that the 
case was one which, ex necessitate rei, must have bid defiance to treatment; it, 
however, suggested one practical consideration, that in similar instances the 
occurrence of previous attacks of intestinal obstruction, should not necessarily 



1842.] Ophthalmology. 197 

lead to the conclusion, that the obstructing cause is not of a permanent organic 
character. Peritonitis is not necessarily present in fatal cases of obstruction of 
the bowels, nor when present, is it the sole cause of death, which is perhaps 
chiefly to be attributed to the exhaustion produced by frequent vomiting, &c. 
Dr. G. has met cases of fatal obstruction, in which there was scarcely a trace 
of peritonitis. — Dublin Medical Press, April 20, 1842. 



OPHTHALMOLOGY. 

60. On certain structures in the Orbit, and an improved method of treating its 
Diseases. By J. M. Ferrall, Esq.— One of the most interesting papers which 
have lately appeared in the British Journals, is this by Mr. Ferrall. It places 
in a new light some most interesting appendages of the eye, and enables us to 
treat some of its diseases with more confidence than we have hitherto been able 
to do. In the year 1835, Mr. Ferrall was called to see a patient labouring under 
a most painful affection of the eye. He had been without sleep for more than 
forty-eight hours. The pain was in the ball of the eye, forehead, and temple, 
and of a most racking and intense kiwd. The eye evidently projected three 
quarters of an inch beyond its fellow; the lids were swollen and oedematous,and 
of a dusky red colour. The conjunctiva of the globe was protruded all round 
the cornea in the manner of chemosis, but its colour was not red nor vascular; 
it had a pale amber colour and manifestly was distended by serous infiltration. 
The cornea and iris were perfectly healthy. 

Bleeding and other severe antiphlogistic treatment greatly relieved for a 
time, but he was not permanently relieved till the system had been affected with 
calomel. 

Now, what was this affection'? The eye was perfectly healthy, the disease 
was evidently in the appendages. There was neither corneitis, sclerotitis, iritis, 
nor retinitis. At first sight it seemed like periostitis, but one difficulty presented 
itself to this explanation; when the upper third of the superior eyelid was 
pressed in such a manner that the pressure was directed backwards towards the 
apex of the orbit, the sufferings were greatly increased; but when it was di- 
rected upwards towards the periosteal covering of the roof of the orbit, the patieni 
did not complain. Besides, periostitis would hardly produce this projection of 
the eye. On account of the difficulty of coming to a just conclusion on the 
nature of this case, Mr. Ferrall resolved to examine the anatomy of the eyeball 
more minutely. He found that a distinct sheath existed around the globe, which 
protected it from the unnecessary action of the muscles, and also assisted the 
muscles in their offices; and it was evidently this sheath, which he names the 
Tunica Vaginalis Oculi, which was affected in the foregoing case. He says: 

" Having separated the divided conjunctiva, we expose, not as has been de- 
scribed by anatomists, a cushion of adipose tissue, but a distinct tunic of a yel- 
lowish white colour, and fibrous consistence, continuous in front with the pos- 
terior margin of the tarsal cartilage, and extending backwards to the bottom or 
apex of the orbit, where its consistence becomes less strongly marked. By 
proceeding in the manner I have mentioned, the parts are displayed without any 
elaborate dissection. The sharp end of a probe, or director, will be sufficient to 
separate the ball of the eye from the new organ, by breaking gently the fine cel- 
lular tissue which connects them. Its colour is totally different from that be- 
longing to its external surface, and it is here perfectly smooth, where the eye 
glides over it in its movements. The muscular substance of the recti muscles 
is nowhere visible, they lie on the outside of this tunic, which insulates and 
protects the eye in the most perfect manner. 

"The most beautiful portion of this mechanism, however, remains to be de- 
scribed. In the concavity of this tunic, and about half an inch posterior to its 
anterior or orbitar margin, are to be found six well defined openings, through 
which the tendons of the vessels emerge in passing to their insertion in the 

17* 



198 Progress of the Medical Sciences. [July 

sclerotic coat, and over which they play, as over pulleys, in their course. The 
tendons are loosely connected to the edges of those apertures by fine cellular 
tissue, which opposes no obstacle to their gliding movements. 

*' The physiology of this tunic, which I have ventured to term the tunica vagi- 
nalis oculi, will be conveniently considered in relation to each of its separate 
offices, namely, as an investment and protector of the globe of the eye, and as 
regulating the direction in which the muscles of the eye are to exert their force. 
In either of those capacities, this new and beautiful apparatus (independent of 
its pathological importance) appears to possess a physiological interest, entitling 
it to a high place among the many evidences of design, with which the animal 
frame abounds. 

'* The uses of this tunic, as a covering, wull be obvious from a brief considera- 
tion of the inconveniences to which, without this protection, the eye would be 
subjected during the action of its muscles. These muscles, it has been inva- 
riably taught, were in close contact with the globe of the eye, on their passage 
to their insertion, the interspaces being occupied by the fat of the orbit. This 
description of the parts, which is to be found in the works of the best authors, 
implies, that during the frequent action of its muscles, the eye must sustain a 
pressure as great and as suddenly applied, as the movements of the organ are 
rapid and energetic. 

*' Now, according to the received anatomy of the orbit, the globe of the eye is 
grasped by the recti muscles in such a manner, that they must, during their 
action, exert upon it, a sudden pressure analogous to that described by Sir 
Charles Bell. And when we consider, that between their origin and insertion 
they include the most prominent portion of the eyeball, it is obvious that the 
sudden swelling of their bellies during their action, (proverbially known to be 
as quick as thought,) must have produced a flash of light, if no protective par- 
tition had existed between them. The use, then, of this tunic as a covering ap- 
pears to be, to separate the eyeballfrom its muscles, and to protect it from pressure 
during ihtir action.^^ 

Another office of this tunica vaginalis oculi is to assist the muscles by means 
of the openings through it, acting like so many pulleys, and thereby enabling 
the recti muscles to act with more power and rapidity in the different motions of 
the eye; and at the same time it prevents these muscles from retracting the eye 
— for "certainly if this tunic had no existence, it would be difficult to imagine 
how the recti muscles could communicate the rotatory movements to the eye 
without in a greater degree exerting a retracting power," The human eye has 
never been seen to be retracted, but wAz/ has never been explained before. Retrac- 
tion takes place in many of the lower animals by means of an especial muscle — 
the retractor muscle; but this is fixed into the globe ?Li its posterior part, near 
the entrance of the optic nerve, and cannot therefore exercise any injurious pres- 
sure on the globe. This tunica vaginalis oculi having been discovered, we are 
better able to understand some hitherto inexplicable diseases. The following 
case illustrates what Mr. Ferrall calls "Rheumatic inflammation of the tunica 
vaginalis oculi," with protrusion of the eye. 

"Laurence Grant, sstat. 32, a carpenter, of dark complexion, and rather strong 
constitution, presented himself at St. Vincent's Hospital, in February, 1838, on 
account of violent inflammation and protrusion of the right eye. The globe of 
the eye projected considerably beyond its natural situation; the cornea and iris 
were healthy in appearance, but vision was much confused. The conjunctiva 
projected remarkably around the cornea, but its colour was pale amber, and 
without any trace of vascularity. The eyelids were both swollen and red; the 
lower part of the upper lid was so much tumefied, that the eiliae appeared to 
grow at an unusual distance from each other; and its transverse diameter was 
considerably increased. The colour of the lid was of a dusky red, and its sur- 
face was marked by a number of distended veins. Although the swelling of 
the palpebra had increased its vertical diameter, and caused it to descend, the 
protrusion of the eyeball was so great as to cause it to be uncovered. From the 
superciliary ridge to the inflamed portion of the eyelid, an interval could be 



1842.] Ophthalmology. 199 

seen, where neither redness nor swelling existed. This space was about half 
an inch broad, and extended the whole length of the lid transversely. 

" He complained of agonizing pain in the ball of the eye, and felt as if it were 
' dragged out of the socket.' This latter sensation he described as never 
ceasing; but the pain was liable to severe exacerbations. He seemed to derive 
some comfort from keeping the palm of his hand pressed moderately against the 
whole tumour, although Ire could not bear the finger of another to be laid upon 
it. The upper portion of the superior palpebra, which was free from redness, 
could however bear pressure, provided it was not made suddenly, or so as to 
shake the whole lid, and that the pressure was directed upwards towards the 
roof of the orbit. When asked, he admitted that he perceived an occasional 
flash of light before his eye; but this appearance was more frequent in the be- 
ginning of the attack. It was now five days since the complaint commenced. 
He went to bed free from pain in the eye, and was disturbed about three o'clock 
in the morning. He had been unable to work for the last week from rheumatism 
in his knees and legs; the limbs were improving at the period of the recent 
attack. He had rubbed the parts affected with turpentine, but had used no in- 
ternal remedy. There was still remaining slight fulness from effusion into the 
capsule of the left knee-joint, and tenderness with tumefaction about the middle 
of the right tibia. 

"This man had suffered severely from syphilis six years before, and had used 
mercury largely. He was now married, but his habits of intemperance, as re- 
garded the use of ardent spirits, were little altered. 

"The temporal artery was opened, and sixteen ounces of blood removed, with 
relief. The improvement however was transient, and the pain returned almost 
immediately. The hospital being quite full at the time, and his lodging near, 
and not uncomfortable, he was allowed to take his medicine at home. Calomel 
and opium, three grains of the former, and half a grain of the latter, were ad- 
ministered every third hour. 

" There was very little amendment until the constitutional effects of the remedy 
were established. This happened on the /ourth day, when the disease began 
to give way. The pain first diminished, the eye then receded, and the redness 
gradually disappeared. The tumid condition of the palpebra, and the distorted 
appearance of the eyelashes, were the last to yield. When the disease in the 
orbit was removed, it was found that the tenderness and swelling of the knee 
and tibia were also gone." 

The following case illustrates rheumatic inflammation of the tunica vaginalis 
oculi, protrusion of both eyes consecutively, and cure by hydriodate of potass: 
"Mary Smyth, aetat. 48, was admitted into Joseph's ward, April 16, 1840, on 
account of rheumatism, with effusion into the capsules of both knee-joints. She 
was a fat, unwieldy person, and was rendered quite helpless by the synovitis, 
although enjoying tolerable health before the attack. No other joint was affected, 
and she was free from fever. Some degree of restlessness attended the pain; 
and the renal secretion was scanty and high coloured. Fomentations were em- 
ployed after the application of leeches, and colchicum administered internally. 
At the end of a week, and when the swelling was nearly gone, she complained 
of acute pain in the right eye. There was no appearance of inflammation dur- 
ing the first twenty-four hours, and it consequently attracted little attention, 
except that an active cathartic was exhibited. On the second day, the upper 
eyelid was inflamed and swollen, and the ball of the eye was observed to project 
a little; the pain was increased, and she was annoyed by occasional flashes of 
light before the eye. Blood was taken from the temple by cupping, and anti- 
monials with purgatives were prescribed. She passed a wretched night, suf- 
fering great agony; and the next day, the phenomena of the disease were fully 
developed. The eyeball projected three quarters of an inch; the cornea and iris 
were healthy, and looked brilliantly clear in the midst of a very prominent che- 
mosis. The colour of the latter was a yellow amber, without any vascularity 
or redness. The lids were swollen but did not cover the eye: the upper lid 
presented the dusky-red colour and tumid appearance described in the last case. 



200 Progress of the Medical Sciences. [^"^7 

The superior portion of its surface, or that next the superciliary ridge, did not 
participate in this change, and the two portions were separated by a very abrupt 
line of demarcation. Pressure on the upper division, when directed upwards 
towards the roof of the orbit, produced no pain. She could see as distinctly 
with the affected eye as with the other. The resemblance to the other cases 
was too striking to be overlooked; and as it was obviously not an affection of 
the periosteum of the orbit, and yet was connected with rheumatism, there could 
be little hesitation in making a diagnosis. I was desirous to know whether any 
other fibrous tissue was engaged, and therefore requested Mr. M'Svveeney, the 
gentleman who noted the case, to uncover the tibiae. Here, although she had not 
noticed it to us, we found distinct swelling, and great tenderness over the left 
tibia, about an inch below its upper end. She then admitted that it gave her 
considerable pain, but her sufferings in the eye were so much greater, that she 
disregarded it altogether. 

" Being at this time satisfied, from researches* already published, of the supe- 
rior efficacy of the hydriodate of potass in periostitis, I determined to trust to it 
alone in combating this formidable disease; but as the organ of vision was in 
danger, I directed that this powerful salt should be administered at shorter in- 
tervals than usual. Ten grains were given every third hour. 

"At visiting hour next day, she had taken seventy grains of the hydriodate. 
She declared herself better, and suffered much less pain, but we could not per- 
ceive much difference in the eye. On the day following, however, every person 
who saw her was struck with the improvement: the whole tumour was greatly 
reduced; the ball of the eye had receded considerably; the chemosis was les- 
sened, and the swelling as well as redness of the lids was diminished. On 
the fifth day from the commencement of the treatment, there was hardly any 
trace of the complaint, and the medicine was therefore discontinued. The tibia 
had now also recovered its healthy state, when, just as we congratulated our- 
selves on the rapid subsidence of so severe an affection, the left eye became the 
seat of pain, and in thirty-six hours presented all the symptoms of the disease. 
The same protrusion of ihe eyeball, the same chemosis and swelling of the pal- 
pebras, and, as in the previous attack, the same integrity of vision and intole- 
rance of light. The hydriodate of potass was resumed in doses of fifteen grains 
every third hour, with a resolve to persist in its use (if it succeeded) for some 
days after the disease appeared to be removed. 

*' On the day following, I had the satisfaction to perceive that the symptoms 
had received a check; and in three days more, to find them altogether nearly 
removed. The hydriodate was continued in diminished doses, and gradually 
lengthened intervals, for ten days after every symptom had disappeared. 

" Protrusion of the eyeball, which, when attempted to be explained by uncom- 
plicated periostitis, requires some stretch of imagination, appears a very simple 
and inevitable result of inflammation of the tunica vaginalis oculi. There are 
here no soft parts to receive and divide the pressure, or protect the globe. The 
tunic is supported by other fibrous layers on its outside, as well as by the mus- 
cles of which they constitute the sheaths. Inflammation of this capsule must 
then be immediately followed by pressure; and when we recollect its conical 
form, and that, as happens in the case of inflammation of other fibrous tissues, 
eflfusion at once takes place into the cellular membrane connecting it to the ball 
of the eye, we perceive there is nothing to prevent the dislocation of the latter. 

"This effusion into the cellular tissue will make itself evident in another way. 
The conjunctiva at the place where it forms the fold, in being reflected from the 
eyelid to the eye, closes up the tunica vaginalis in front. At this point it will 
not only receive the pressure of the effused serum, but will become separated 
from its connection with the sclerotic coat, by the extension of the infiltration; 
hence the amber coloured chemosis without vascularity of the conjunctiva. 
Chemosis originating in conjunctivitis always presents, in addition to serous 
infiltration beneath, one or other of the forms of hyperaemia. The chemosis of 

* Medical Gazette, April 10, 1840. 



1842.] Ophthalmology. 201 

which we treat is, in uncomplicated cases, the consequence of effusion from a 
deeper source. [ can easily imagine the extension of inflammation from the 
fibrous structures of the lid, to its conjunctival surface, and thence to the scle- 
rotic conjunctiva; bat this complication did not occur in the cases which I 
have related. 

" In distinguishing those cases, I would not be supposed to mean, that inflam- 
mation of this tunic is a disease apart, and never combined with a similar condi- 
tion of the periosteum or cellular tissue, on the one hand, or inflammation of the 
eyeball itself, on the other. I am aware they may exist together, for I have 
seen such cases. All I mean to assert is, that inflammation of the tunic de- 
scribed, may be the primary aflfection, and the point of departure from w^hich the 
diseased action may spread to the other fibrous layers in the orbit, and finally 
reach the periosteum; and that the attack may even be limited to the tunica 
vaginalis oeuli — that it may here produce a train of symptoms of the most dan- 
gerous kind, and which have been hitherto supposed to reside in the periosteum, 
because the existence of other fibrous membranes in the cavity was not sus- 
pected." 

Mr. Ferrall shows the value of being acquainted with the anatomical struc- 
ture he has described, in other cases, such as "adhesion of the tunica vaginalis 
to the globe of the eye from inflammation," "abscess between the tunic and the 
globe," " tumours within the tunica vaginalis oculi;" and lastly in the " extir- 
pation of the globe." Respecting this last operation he makes the following 
valuable remarks. 

"The comparative safety of an operation limited by this fibrous tunic is obvious, 
but an additional recommendation will be, the facility of its performance. The 
conjunctiva being freely divided, the six tendons may be snipped across with a 
scissors one after another, where they emerge from the tunic. The eyeball will 
then be easily detached by a probe or director passed freely around it; when one 
step alone would remain — the division of the optic nerve. When we recollect 
that the roof of the orbit is occasionally found to be as thin as paper in some 
parts, it will appear most desirable to avoid stripping it of its coverings, by 
operating within this second orbit, or proper fibrous socket of the eye." 

Mr. Ferrall ends his interesting paper by the following summary. 

"The reflections suggested by a review of the cases which led to the present 
inquiry, as well as of this new and curious mechanism itself, may be reduced to 
the following propositions: — 

1st. That the description of anatomists, which places the globe of the eye in 
contact with the fat and muscles of the orbit, is erroneous. 

2d. That there exists a fibrous tunic, investing and insulating the eyeball, 
and separating it from all the other structures in the orbit. 

3d. That the uses of this tunica vaginalis oculi are, to present a smooth sur- 
face, facilitating the movements of the eye; and by its density and tension, to 
protect it from the pressure incidental to the swelling of its muscles during their 
action. 

4th. That the openings in this tunic perform the oflice of pulleys, giving a 
proper direction to the force exerted by the muscles, — securing the motions 
of rotation, and opposing those of retraction, which would otherwise pre- 
dominate. 

5th. That certain cases of disease within the orbit, accompanied by protrusion 
of the eyeball, are to be explained, only by reference to the tunica vaginalis 
oculi, and the other fibrous tissues now described. 

6th. That a correct knowledge of the anatomy of the orbit and of the fibrous 
structures alluded to, is essential to the operating surgeon, in dealing with ab- 
scesses and tumours, in extirpation of the eyeball, in the operation for strabismus., 
and all operations on that cavity." — Braithwaite' s Retrospect^ No IV, from Dub- 
lin Journ. Med. Sci. July 1841. 

61. Rupture of the Sclerotica by a blow ivith the Fist. — John Hays, aged 39, 
was admitted into Middlesex Hospital, under Mr. Arnott, Oct. 4th, 1841. This 



202 Progress of the Medical Sciences, [July 

man, who had but one eye, the left having been destroyed by an attack of severe 
inflammation, and rendered atrophic many years ago, received a blow on it last 
right from a man's fist, at the door of a poblichonse, and was immediately 
deprived of sight. The globe is very red, not from inflammation, but from blood 
extravasated under the conjunctiva, and into the anterior chamber. In the 
former situation it is principally under that part of the membrane which covers 
the upper half of the eye; in the latter the pupil is covered and a great part of 
the iris, yet this membrane at its lower part can be seen. The conjunctiva is 
entire; he cannot distinguish light from darkness; there is a trifling bruise of the 
lower eyelid; has little pain in the eye, and no headache; smells of gin, under 
the influence of which he is still. To have twenty-five grains of compound 
jalap powder directly, and the lead lotion to the eye. Confinement to bed and 
low diet. 

Mh. No pain; bowels acted tolerably. To have a compound senna draught. 
Continue lotion. 

1th. So much absorption of the blood effused under the conjunctiva has taken 
place, that a rent in the sclerotic coat, at its upper part, can be perceived, about 
a quarter of an inch in length, and running parallel to the edge of the cornea, at 
the distance of l-16th of an inch. The pupil also can be recognised, but not of 
its natural size, form, or situation. It is very large, oval, and close to the mar- 
gin of the cornea, at the upper part, that which corresponds to the injury of the 
sclerotic. The iris is observed to be tremulous. The globe to the touch is soft 
and flaccid. 

llth. Absorption further advanced. Rent in sclerotic gapes as if something 
slightly protruded through it. It is now distinguished that one side of the oval 
pupil is formed by the circular edge of the cornea, the iris having disappeared at 
this part; sees a large body of light. To have five grains of blue pill night and 
morning. Continue the lotion. 

IQth. Blood in anterior chamber entirely removed, that under conjunctiva 
nearly so; rent in the sclerotic less gaping, more light seen; can distinguish the 
form and outline of persons. 

21s^ Sight improving; can see the hand, and tell the number of fingers ex- 
tended; edges of the crack in the sclerotic now approximated, so that it now 
shows as a mere line; globe less flaccid; it has more fulness and firmness; iris 
still tremulous; gums very tender, with mercurial fcetor of the breath. Omit the 
pills. 

2bth. Can now see to the end of the ward. 

Nov. \st. He says that his sight is weak. To have a blister to the forehead. 
^ih. His sight is now as good as it was before the accident; the cicatrix of 
the rent in the sclerotic is barely distinguishable. 

Oct. 2Sth. In some clinical remarks on this case to-day, Mr. Arnott observed 
that the eyeball was well protected by its deep situation, and was seldom injured 
by a blow of the fist, as our pugilistic encounters sufficiently attested, although 
such an injury might occasionally happen. 

In the condition in which the man's eye and sight were on his admission, he 
(Mr. Arnott) had stated at the time that caution was required as to what should 
be said of the chance of the recovery of sight; for its loss might depend either 
on the blocking up of the pupil by the extravasated blood, or it might be con- 
nected with laceration or bruise of the deeper parts of the eye, especially the 
retina. 

With the view of assisting him in determining on which of the two causes 
just mentioned the loss of sight depended, he endeavoured to ascertain from the 
man whether any interval, however brief, intervened between the receipt of the 
blow and the total loss of vision, but he could not get a satisfactory answer. 
The man was, in fact, muddled at the time of the accident: he asserted, how- 
ever, that he was instantly deprived of sight. Had he (Mr. Arnott) been able 
to make out that there was an interval, he should have thought more favourably 
of the case; but when, three days after his admission, he found that the sclerotic 



1842.] Ophthalmology. 203 

was actually burst and the pupil displaced, that the eye was flaccid and the iris 
tremulous, he expressed himself as having- little expectation of the sight being 
restored. The displacement of the pupil, as observed in this case, was not an 
unusual effect of blows on the eye. It seemed to depend on an injury done to 
the ciliary ligament, or nerves, the iris at the part corresponding to the blow or 
injury, contracting and disappearing. On the other hand, from a blow the iris 
sometimes became separated or detached from the ciliary ligament, and then a 
double pupil was formed. 

The treatment of the case was sufficiently simple; there was effusion of blood 
within the eye, but no sign of inflammation. The removal of blood was to be 
the work of nature; we could do little to help her, except by preventing inflam- 
mation, which would have interfered with the process, but of which there were 
no signs in this case. The patient w^as not bled, not even by having leeches 
applied. He was not of full habit, and had an indifferent pulse. He was 
purged, and kept on low diet, and cold was applied to the eye: these remedies 
were found sufficient. 

Notwithstanding the unpromising appearance, the case turned out better than 
was anticipated. Seven days after his admission, he could distinguish light 
from darkness, and his sight gradually improved in proportion, apparently, to 
the removal of the blood from the interior of the eye. He took mercury with the 
view of aiding absorption, but the lecturer questioned if it had much to do with 
the improvement. 

One day after the pupil became visible, the patient hearing him advert to the 
situation of it at the upper part of the eye, informed him that it had been so for 
the last four years. That at that time being in India, he had received a blow 
from a man; and that the nail of his thumb wounded his eye, and that the sur- 
geon who attended him then told him of the alteration in the pupil. There is 
no reason to doubt the man's statement, though possibly, with regard to the in- 
jury by the nail, there might be some question, as he only mentioned this after 
hearing how the patient in the next bed had been injured. Since the accident 
in India his sight had not been so good as previously, yet up to the occurrence for 
which he entered the hospital, he was able to follow the calling of a newsman, 
and could read with the aid of glasses. He had now nearly recovered the same 
power of vision, and would leave the hospital next week. 

62. Symblepharon. — M. Petrequin, of Lyons, has performed a somewhat 
novel operation for the cure of this species of deformity, the result apparently, 
in the case recorded, of repeated operations for pterygium. A gentleman of 
Clermont, Savoy, was affected with pterygia in each eye,, caused by chronic en- 
gorgement. In 1834, Mayor, of Geneva, operated on him, and the left eye was 
perfectly cured; the pterygium in the right, on the contrary, returned at the end 
of a month, and was attended with pain and some difficulty in the motions of 
the eye. The second time he was operated on by M. Maunoir, but with tempo- 
rary success. The pterygium returned, and increased rapidly. Riberi, of 
Turin, who was next consulted, excised a portion of the caruncle with the ptery- 
gium, and applied caustic afterwards. This time fibrous bands formed, causing 
adhesion of the eyelids to the globe of the eye. These bands were excised by 
a physician at Chambery, the operation being followed by large granulations, 
which were extirpated again and again, and finally repressed by the application 
of the sulphate of copper and nitrate of silver. Cicatrization took place gra- 
dually, but at the same time there formed a mass of fibrous bands, disposed fan- 
shape, the base attached to the internal surface of the two eyelids, the apex ex- 
tending to and terminating on the cornea, which it partially covered to the extent 
of two lines (l-6th of an inch.) M. Petrequin saw the patient in this state on 
the 10th of April, 1841, and on examination found the eyelids bound together 
and to the eye, by a multitude of dense, fibrous bands, which rendered their 
molion very difficult. When the patient looked outwards to the right he had 
double vision, as also, but in a less degree, when he looked much to the left. 



204 Progress of the Medical Sciences. [Ju^y 

Cold, exposure to the air, readingr, and writing were painful and fatiguing. He 
could not turn the eye outwards. 

This case was not unattended with difficulty, in consequence of the great ten- 
dency to relapse and to an increase of the disease. Excision, incision, and the 
application of caustic, had already failed; a new operation was therefore requi- 
site, which was performed in the following manner on the 13th: — A small curved 
needle, armed with a double thread, was passed between four or five of the fibrous 
bands of the lower eyfelid and the globe of the eye, and the threads tied, the 
inner ligature being tied somewhat loosely. The operation was repeated the 
next day, the ligatures being placed external to those already applied. The eye 
was kept immovable, and bathed with cold water and laudanum. On the 15th 
the adhesions of the corneal side were broken; the part was touched with caus- 
tic alum, and a little charpie passed behind. The sulphate of copper was applied 
lightly the four following days; the other ligatures separated later; the lower 
eyelid was set at liberty, and became free and mobile, and a cure was effected. 
A similar operation was afterwards performed on the bands of the upper eyelid, 
but the results were not so successful. It was followed by a high degree of 
inflammation, requiring the application of leeches, mustard pediluvia, purga- 
tives, &c. and when the patient left Lyons the eyelid was only partially freed, 
but its motions were more easy. M. Petrequin heard from him six months after- 
wards, and he was doing well. A few months later he was informed indirectly 
that the improvement the patient had experienced had not continued entirely. A 
second case, of an equally interesting nature, is recorded by M. Petrequin, in 
which the adhesion of the eyelids to the eye had been caused by the application 
of quick-lime. The patient was a young blacksmith, and had "been operated on 
seven times unsuccessfully previously to his placing himself under the care of 
M. Petrequin. The adhesion affected the lower eyelid chiefly at the external 
canthus, but the commissure was also engaged; the motions of the eye were 
difficult and painful, and there was present a degree of strabismus convergens, 
with diplopia, imperfect vision, &c. The ligatures were applied four or five 
times, each successive application being followed by apparent improvement. 
The first was applied on the 11th of July, and when the patient left the hospital 
on the 30th the adhesions were entirely destroyed, and vision perfect, but cica- 
trization was not quite completed. The patient was to return in September, if 
any contraction or difficulty of motion appeared afterwards, and, as he had not 
done so, M. Petrequin concludes him cured. 

The object of M. Petrequin in applying a double ligature to these bands, tying 
one tightly, and the other more loosely, was, that the separation of the threads 
should take place at different times, so that the wound caused by the ligature 
tightly applied might be healed, or nearly so, before that to be produced by the 
more loose one, should be actually open, thus inducing cicatrization of each 
separately, and thereby preventing their reunion. The portion of the fibrous 
band between the two ligatures could not form adhesions to either wound, inas- 
much as it was in a state of strangulation, and must necessarily fall atrophied. 
The more dense and fibrous the bands, the more easy is it to cause a difference 
of several days between the separation of the respective ligatures, attention 
being paid to their being tied in different degrees of constriction. If the bands 
are very thick, the ligatures must be applied again and again, the needle being 
passed each time deeper and deeper. After the operation, it is requisite to keep 
the eye perfectly motionless and closed, to prevent those motions, which might 
cause traction on the eye, and separate the ligatures sooner than was intended. 
— Prov. Med. and Surg. Juurn. May 7, 1842, from Gaz. Med. de Paris. 

[Of the safety of this operation of M. Petrequin it will require farther expe- 
rience to convince us. We have seen a case somewhat similar to that first 
related, and induced by the same cause, ill judged, repeated operations for the 
removal of pterygium. The operations of some modern surgeons on the eye can 
scarcely be exceeded in rudeness.] 



1842.] Ophthalmology. 205 

63. Turpentine in Scrofulous Corneiiis. — Mr. Obre relates in the Lancet, Ap. 
30, 1842, two cases of scrofulous corneitis successfully treated by turpentine. 
He gave the medicine in doses of from half a drachm to a drachm three times 
a day. 

64. Irideremia. — Mr. France has published a case of absence of the iris in 
both eyes, in the person of a young woman, an oui-palient at the eye infirmary 
at Guy's. She is unable to bear exposure to a strong- light; sunshine in particu- 
lar is disagreeable to her, and causes profuse lachrymation. Objects are only 
distinctly seen when within the distance of a foot or two. The eyelids are 
habitually more than half closed; the globe of each eye affected with an almost 
incessant oscillatory motion in a horizontal direction, and the power of directing 
the eye towards an object, particularly upwards or downwards, is much im- 
paired. The cornese are partially clouded. "The sclerotic coats are mode- 
rately healthy — perhaps rather more bluish than natural; their degree of tension 
is that of health. On inspecting the right eye very carefully, and looking above 
or beside the corneal nebula, there is observed a central opacity of the anterior 
capsule of the crystalline, about the size of a large pin's head; and a similar 
spot is also to be seen on the posterior capsule, the lens remaining perfectly 
transparent. Thus a very satisfactory illustration is afforded of the size of the 
space between the cornea and capsule; and, again, between the front and back 
walls of the cavity within which the lens is contained. In the left eye, the 
centre of the anterior capsule, or more superficial parts of the lens, is opaque; 
while the posterior, appearing as if corrugated, is opaque also in the centre, to 
about one-third of its extent, and shoots forwards, as it were, flakes of opacity 
into the lens on the nasal side. 

*' Witli these exceptions, the entire space viewed through either cornea is of 
uniform brownish black hue. The closest examination does not disclose any 
vestige of iris." 

Of this singular malformation, Lawrence has seen two examples in children, 
Middlemore one. Von Ammon, of Dresden, has depicted several. He says, 
in describing them, that the sclerotic coats have been invariably found free from 
bluish tinge, and decidedly white — that the condition of the lids is always, or 
generally, that noticed above — that cataract always sooner or later occurs, and 
should not be interfered with, and that sometimes this malformation has dis- 
played the strongest disposition to hereditary transmission. Oscillation of the 
globe also seems to be very frequent.— -Gt^^/'s Hospital Eeporis^ April, 1842. 

65. Imperfect development of the Eyes with Cataract — The following very in- 
teresting and rare case of imperfect development of the visual organs is related 
by Mr. Walker, of Manchester, in our esteemed contemporary, the Provincial 
Medical and Surgical Journal, (Jan. 15th, 1842.) Mary Wild, aged one month, 
admitted an out-patient, July 20, 1841. The external aspect, when the eyelids 
are closed, is that of great depression, such as is seen after the evacuation of the 
humours, the palpebrae being flattened instead of possessing the convex appear- 
ance observed in the normal state. On separating the lids, the eyes have the 
same sunken and flat appearance, resembling those of a small bird, being evident- 
ly imperfectly developed; the corneai are transparent, but not more than half the 
usual dimensions; the irides of a dark blue, and a greyish white body — evidently 
the opaque lens — is seen within the pupils, which latter are of the ordinary size. 

No other morbid appearance is observable. There has, however, been a 
slight mucous discharge from the conjunctival surface of both eyes, almost ever 
since the period of birth, but this is inconsiderable. The child occasionally 
opens both eyes, and appears to fix them on the window as if sensible of the 
presence of light. In other respects she is in good health. 

The usual local and general remedies were ordered, with a view to the cor- 
rection of the morbid secretion from the conjunctival surface. 

July 23cZ. The mucous discharge much abated. Ordered extract of belladonna 
to be rubbed around the eyes every night. 

No. VIL— July, 1842. 18 



206 Progress of the Medical Sciences, [July 

27th. The pupils are considerably dilated, and the lenses are seen to be per- 
fectly opaque. 

Jan. ith, 1842. The child has been occasionally broncrht to the hospital since 
the last report, but no change is perceptible in the appearance of the eyes. The 
mother is unable to satisfy herself as to whether the child exhibits any real sen- 
sibility to light. She often places a lighted candle before the eyes, but thinks 
that no notice is taken of il. The child is now very delicate in appearance, and 
its health not very good. Whether the retina is sensible or otherwise is difficult 
to decide. Should the health improve, and some evidence of the sensibility of 
the retina become apparent, it will perhaps be desirable to operate for the re- 
moval of the cataracts. This is a very interesting and extremely rare case of 
malformation, or rather of imperfect development of the visual organs. 

66. Cases in which, after the failure of the operation for Cataract on one eye,, 
the vision of both eyes was restored, tjy operating on the cataract on the op' 
posite side. — M. Serre, Prof, of Clinical Surgery at Montpellier, relates three 
cases, in which, after the lapse of months (in one case three years) from the un- 
successful operation for cataract upon one side, the sight of both eyes was re- 
stored by operating on the other cataract. The conditions common to all these 
cases were, a momentary recovery of sight immediately after the first operation, 
a free state of the pupil with no obstacle to the arrival of the rays of light at the 
retina, and, to all appearance, only a partial extinction of the sensibility of that 
membrane. Under these circumstances, it would seem that the sudden stimulus 
of the light admitted into the eye newly operated on, is sufficient to call into 
sympathetic action the dormant nervous energy of the retina on the opposite 
side. And if more observations of the same nature should present themselves, 
it may come to be a question whether, in certain cases of amaurosis, particularly 
in the asthenic form, light may not be advantageously used as a stimulant to the 
eye by means of glasses adapted to that purpose. Again, instead of declining 
to operate for cataract so long as vision remains in one eye, though in an im- 
perfect degree, may we not attempt the operation under certain circumstances, 
with the very object of restoring vision to that eye] Lastly, in opposition to 
the ideas of some ophthalmologists, may not the excitement produced by the 
operation, or by the contact of light, contribute to restore vision, in some cases 
of cataract complicated with incipient amaurosis'? — Land, and Edin, Monthly 
Journ. Med Set.., May 1842, from Gaz. Med. de Paris. 

67. Melanosis of the Eye. — The following case of this disease, operated on by 
Dr. Byron, Surgeon to the Navan Infirmary, was communicated to the Surgical 
Society of Ireland. 

" Richard Donnelly, a labourer, aged 21 years, was admitted into the Meath 
Infirmary on the 24th March, 1827. Hair and complexion dark, his left eye 
was affected with cataract, and with what appeared to be amaurosis ; the con- 
junctiva was extensively chemosed, and the eyeball somewhat enlarged; the 
inflammation and lachrymation inconsiderable. He complained of headache, 
his pulse was 60 and full, his general health was good, and his constitution 
robust; he had had no vision in the eye for a year; the other symptoms were 
only of a week's standing, and had been produced by striking the eye against 
a stick. Three weeks afterwards it was deemed expedient to perform the opera- 
tion for staphyloma; as the functions of the eye were irretrievably gone, it was 
hoped the eye would, after the discharge of the humours, and in consequence of 
the enlarged vessels being unloaded, probably sink into the socket, and give no 
further trouble. The operation was accordingly performed on the 27ih March, 
somewhat more than three weeks from the time of his admission. The sclerotic 
and choroid coats being divided three lines behind the ciliary ligament, and a 
large segment made of the ball, which included within it the lens in an opaque 
state, with its capsule and the iris; the vessels in general bled freely, and some 
coagulated blood found its way into the anterior cells of the vitreous humour. 
He had an anodyne at bedtime, but nolw^ilhstanding, suffered severe pain in the 



1842.] Ophthalmology, 207 

eye and slept none. An emollient poultice and water dressing were applied. 
The wound discharged pus and bloody matter in moderate quantity, and for 
some days the swelling appeared to be gradually diminishing; however, on the 
29th April, about a month after the operation, the report was, that the wound 
had filled up and the eye was as large as before the operation, having an uniform 
fungous aspect. At this time he suffered little uneasiness and wished to go 
home — he was therefore discharged. 

" On the 2d February, nine months afterwards, he again presented himself; 
the tumour had very considerably increased in size within the preceding three 
months, and was then as large as a middle sized orange. Its circumference at 
the base, including the lids, measured nine inches, in the centre seven inches 
and a half, and at the top six inches; the upper eyelid was extended for two 
inches over it, and the under eyelid for one inch; and they both adhered to its 
surface through the medium of the conjunctiva, which was moveable upon it. 
The anterior surface of the tumour had lost its smooth uniform condition, and 
now presented an irregular aspect from the existence of three protuberances 
upon it, each about the size of a walnut. The most prominent, and at the same 
time, the most internal of these, was of a dark purple colour, and bled when 
touched; the others had a somewhat less vivid tinge, intermixed with a light 
pink shade; and the base of the tumour partook of the same colour. To the 
touch it was firm, elastic especially in the situation of the projections, and in 
some places hard. The patient stated that it had sometimes discharged so much 
as a pint. of blood at once; his general health was somewhat impaired. A 
fortnight after this report, on the 16th February, he was re-admitled into the 
infirmary. At that time the disease was evidently advancing with rapidity. The 
central and external protuberances had increased, and presented in addition to 
their former colours, a greenish aspect; their surface also was partially ulcerated; 
three ulcers appeared upon them, and one upon the lid itself, near the eyebrow. 
All the ulcers discharged a small quantity of ichor, and the tendency to hemor- 
rhage appeared in a great measure to have ceased — he now for the first time, 
complained occasionally of severe pain in the tumour shooting to the back of his 
head; and there was a slight degree of chronic inflammation of the upper eyelid. 
His pulse was 80, and moderate, and his general health, though somewhat im- 
paired, had not suffered materially. 

" The operation of extirpation of the globe was performed on the 28th Feb- 
ruary, one year from the time of his first presenting himself at the infirmary, and 
two years from the original commencement of the disease in the eyeball. 

" Operation. — An incision was first made from the external comniissiire of the 
eyelid, to the external angle of the orbit; this from the elongated state of the 
lids was fully an inch and a half in length. An incision was next carried 
through the conjunctiva covering the tumour, from the inner angle of the eye 
along the hairy margin of the under eyelid to the outer angle, where it joined the 
first incision. A similar division of the conjunctiva was made above along the 
border of the upper eyelid which also joined the first incision at the outer angle 
of the orbit. 

"The conjunctiva and lids were now stripped from the tumour above and below, 
until its surface was completely exposed all round, as far as the margins of the 
orbit. The tendon of the superior oblique muscle was next divided on the left 
forefinger, and subsequently that of the inferior oblique muscle in the same 
manner. The division of these tendons allowed the fingers to be passed freely 
round the orbit in all directions. The remaining attachments of the tumour, 
which were extensive, were afterv.^ards divided, and the diseased mass, which 
was of great size, its posterior half filling up the orbital cavity, was removed. 

"The OS planum was perforated for a space as large as the nail of the fore- 
finger, and the edges of this perforation were rough. There was a smart hemor- 
rhage from the ophthalmic and infra-orbital arteries; this was stopped by com- 
pression with lint and the fingers during the time that some portions of thickened 
fat and cellular substance were being removed. The orbit was then filled with 
lint and the bleeding quickly ceased. A portion of the upper eyelid including 



208 Progress of the Medical Sciences. [July 

the ulcer was excised. The patient lost about eight ounces of blood. He sus- 
tained the operation courag-eously. 

" Examination of the tumour. — The report taken at the time stated it to be a 
diseased structure ^ sui generis,'' resembling neither cancer nor fungus hasma- 
todes. I have now no hesitation in pronouncing it to have been a good example 
of melanosis — the report goes on to state that there was no appearance what- 
ever of the lachrymal gland, and scarcely a vestige of the healthy eye; in place 
of the eyeball was a fleshy firm mass, on the surface of which ran the straight 
and oblique muscles, increased in size, particularly the obliquus inferior, abduc- 
tor, and adductor. Beneath these was a strong tendinous fascia, or fibrous 
membrane, apparently the sclerotic coat extended and altered in its nature, on 
stripping off which the surface of the tumour was exposed; the entire superficies 
was rendered irregular by numerous projections or tubercles of various sizes, 
from the dimensions of a pea to that of a chestnut, the larger being of a dark- 
brown or blackish colour, the smaller of a light-brown hue. Between these 
tubercles was interposed a white demicartilaginous substance; the larger projec- 
tions on being divided exuded a matter similar to the pigmentum nigrum of the 
choroid coat, and were composed of a more dense structure of the same nature; 
the centre of the tumour, for an extent equal to at least one third of the entire 
mass, was occupied by a similar substance. The smaller tubercles on being 
cut into presented an aspect of the same sort, but lighter in colour; som« of them 
were firm to the touch, others soft; the largest ones were generally softest. 
The optic nerve was sound, but narrowed near its junction with the eye. As 
to the termination of the case, he progressed favourably to a satisfactory cure. 
He was treated like other patients who have undergone operations of magnitude 
— his fever was moderate— his pulse never rising above 80 — for some days he 
complained of a slight headache, which did not, however, interrupt sleep, and he 
was somewhat annoyed by a swelling of the eyelids and left side of the face. 

" On the tenth day these symptoms had disappeared; the entire cavity looked 
healthy and was granulating rapidly: the denuded bone was covered and the 
eyelids had regained their natural size, the upper lid appearing at this time to 
be scarcely of sufficient size to allow of its covering the exposed socket. The 
edges of the wound in the upper eyelid had approximated. 

"On the twentieth day half the cavity had been filled up — on the sixtieth day 
there was no longer a cavity in the place of the eyeball, and the lids adhered to 
the granulations proceeding from the socket, and thus covered the socket so as 
to diminish deformity. On the eighty-eighth day the wound was completely 
healed, and the appearance of the parts good. There was a slight natural se- 
cretion from some small portions of conjunctiva which had remained adherent to 
the tarsal cartilages. He was discharged cured, and continued well, and 
perfectly free from any return of his complaint, as I had an opportunity of 
ascertaining for nearly four years afterwards, when he was carried off by 3. fever. 

"Mr. Houston said the details of some other cases of melanosis were given 
by Dr. Byron in the paper which he held in his hand, but as he understood 
from Mr. Adams that they would be shortly published, he would not take up 
the time of the meeting by reading them. He wished to add that a preparation 
was preserved in the Museum of the College, of a case similar to that" under 
consideration; the morbid specimen had been presented by Mr. Palmer, and the 
account of the case will be found in the catalogue of the Museum; this patient 
lived for seven years after the operation, and, on examination after death, 
unequivocal signs of the disorder were found in several of the internal organs. 

" Mr. Adams said, the case just read appears to me a very interesting example 
of malignant disease of the structures of the globe of the eye combined with 
melanotic deposits, and we derive some little encouragement from the relation 
of such facts to undertake the very severe operation of extirpation of the eye. 
There were three cases, as far as the affection of the organs contained in the 
orbit was concerned, in the Richmond Hospital, which were somewhat similar 
to that related by Dr. Byron, but were not so fortunate in their termination. In 
one of these cases the operation of extirpation was performed, and the result was 



1842.] Ophthalmology. 209 

unfavourable; in the other two we had to congratulate ourselves that no opera- 
tion had been resorted to, as the post-mortem examination showed extensive 
malignant disease of the liver, with melanotic deposits in other organs. The 
preparations, showing the morhid alterations of structure, have been preserved 
by our learned curator, Mr. Smith. One of these cases, Levy, was under the 
care of the late Dr. M'Dowell; the other was a patient of our learned Vice-Pre- 
sident, Dr. O'Beirne. He will be able to furnish you with more accurate par- 
ticulars relating to it than I can. The third case was under the care of Dr. 
M'Dowell. With respect to the first case, that of Levy, astat. 67, he had the 
disease of the eye for six years, and the operation of extirpation was performed; 
some months afterwards he died with symptoms of disease of the brain, but no 
post-mortem examination was permitted. The interior of the globe of the eye 
was filled with melanotic matter, mixed with portions of a firm, white, scirrhoid. 
structure; the morbid mass was still enclosed in the sclerotic coat. Dr. 
O'Beirne's case, Larrify, was a man of 60 years of age. He had disease of the 
eyeball, which was much enlarged, and the man had been blind for many years 
— he died hectical. Upon dissection it was found that the structures contained 
in the orbit had undergone complete disorganization, the result of malignant 
disease. A vertical section of the tumour is preserved in the Museum of the 
Richmond Hospital, and this section exhibits a mixture of the matter of mela- 
nosis, with the white fibrous tissue of scirrhus, producing, as Mr. Smith re- 
marked, an appearance not unlike certain kinds of marble. The tumour was of 
considerable size, being, in its vertical diameter, about three inches; and in its 
antero-posterior four inches; it had projected far in front of the orbit, and had 
penetrated the optic foramen; the remains of the cornea and sclerotic were found 
in the most inferior part of the tumour. The circumstance in this case, most 
worthy of the attention of the practical operating surgeon is — that, coinciding 
with this malignant disease of the eyeball, the liver was affected with a mixture 
of melanosis, and the tubercle circumscripta, or white tubercle of Dr. Farre. 
The spigellian lobe was perfectly black from infiltration, with melanotic matter 
surrounded with a cyst. This lobe was increased eight or ten times its normal 
size — it was in fact the size of a small melon; throughout the remainder of the 
liver were many tubercles, some while, others black, and there were others 
again, presenting both colours. A careful examination of the brain discovered 
no lesion there; but the optic nerve was implicated in the disease as far back as 
the optic foramen, which was much larger than this aperture normally is. He 
believed the valuable communication brought before the Society last winter by 
his friend, Mr. Smith, would be in the recollection of the members, in which 
Doctor M'Dowell's case of melanosis of the eye, combined with extensive 
melanotic deposits in the internal organs, was detailed and commented upon. 
The preparations are preserved in the Museum of the Richmond Hospital, and 
are well worth examination. Mr. Adams said before he sat down he wished 
to mention that Dr. Young, Surgeon to the Monaghan Infirmary, had given him 
some of the details of a case of melanosis of the eye, in which he had performed 
the operation of extirpation of the eye, and, as Dr. Young was present, he was 
sure he would have much pleasure in communicating the particulars to the 
Society. 

*' Dr. Young said he regretted he had not the notes of the case (to which Mr. 
Adams had alluded) by him; as far as his recollection served him the patient 
was a man aged about 50, but looking older, who applied to him, with a small 
livid tumour, about the size of a pea, growing from the conjunctiva; it was easily 
removed with a scissors; the patient returned in some months with a second 
tumour; it was not, however, seated in the cicatrix, but on the opposite side of 
the cornea, and this he also removed. In about five months the patient again 
returned; he now complained of violent pain in the head; the eyeball was 
enlarged, had a tuberculated appearance, and protruded from the socket; the 
pain was intolerable; I told him that his only chance of relief was in the extir- 
pation of the eye, to which he refused to consent; he went away, and, after 
some time, again returned, and begged of me to perform the operation, which, 

18* 



210' Progress of the Medical Sciences, [Ju^y 

after some time, I did; the orbit filled up, and the wound healed, as in the case 
described by Doctor Byron. Some months subsequently, however, a tumour 
formed in the site of the parotid gland, and the patient died. 

"Dr. Jacob said he had brought with him a drawing taken a number of years 
ago, which he exhibited to the meeting. The patient was a woman between 60 
and 70 years of age; there was a growth of rounded granular masses projecting 
beyond the lids, which was so much like malignant structure that he recom- 
mended its removal. There was little blackness superficially, but it became 
quite evident when a section was made of the tumour, he has no doubt that it 
was a case of melanosis of the eye: 12 months afterwards he saw the patient 
well. He had a case lately of melanosis in a young man which was in the 
form of a single black dot, about the size of a pea, situated upon the lid, which 
commenced as a small vascular tumour: he removed it, including a large piece, 
by means of a V incision: the wound did not heal by the first intention, but 
cicatrization was effected with very little deformity. There has been no return 
of the disease in this case. 

" Mr. Adams— As melanosis of the eye is not much spoken of by English 
authors, at least the ordinary works on diseases of the eye do not give many 
authentic cases of this disease, I may therefore mention, that last summer I had 
nnder my care in the Richmond Hospital, a man aged 68, Garret Doyle, affected 
with melanosis of the lower eyelid of the right eye; it had originated in a small 
tumour about the size of a black currant in the lower eyelid, and had remained 
stationary for some years; it then began to increase, and upon its sides and all 
round, similar tumours appeared, so that when the man was admitted into the 
Richmond Hospital, it had attained the size of a small orange; it was dark 
coloured, and lobulated throughout, and bled whenever it was touched; its pedi- 
cle was very small and therefore it was readily excised; much of the eyelid was 
however of necessity removed with it, the hemorrhage was easily restrained, 
and the wound speedily healed — the man left the hospital, and we have not 
since heard of him — a section was made of the black lobulated mass which was 
removed. Mr. Adams said, that the first drawing he held in his hand gave an 
excellent idea of the external appearance of the tumour, and the expression of 
countenance of the patient; the second drawing showed the structure of the entire 
of the morbid mass, the colour of the tumour externally was black, but on a sec- 
tion of it, exhibited a white interior. The reverse was the case in the melanotic 
tumour, presented this evening by Dr. Jacob, for, in his case the tumour was 
only black in the interior. 

"Mr. Rumley said he regretted Mr. Palmer was not present; however, he had 
a perfect recollection of the case to which Mr. Houston had alluded — several 
surgeons had refused to remove the diseased eye, Mr. Palmer performed the 
operation, and it was so successful, that the patient lived seven years after- 
wards. On examination after death, there were evident signs of the disease in 
several of the internal organs. 

" Dr. O'Beirne said, although the hour for adjourning had arrived, he could 
not resist stating some of the particulars of a case which he has no doubt was 
one of melanosis, and which occurred so far back as the year 1818. The patient, 
a gamekeeper in the employment of the Earl of Granard, was completely blind 
of the right eye; on examination he found a granular tumour exactly covering 
the cornea of a perfectly black colour, and in shape and size resembling a small 
blackberry; it was moveable, and could be raised from the cornea by means of 
a forceps. He lifted it with a hook, and then dissected it carefully off: imme- 
diately afterwards the patient said he had some vision in the eye: the cornea was 
delicately flocculent, but cleared perfectly under the application of a solution of 
nitrate of silver, and in a fortnight the patient was able to return to his employ- 
ment, and to shoot with his usual accuracy. This man was alive three years 
afterwards, but he had not heard further of him — at that time the disease was 
but carelessly observed, and not named. He (the President) sent the tumour 
as a curious one to Sir P. Crampton, who will probably recollect it and the ac- 
count given of it." — Dub, Med. Press, April 20, 1842. 



I 



1842.] Midwifery, 211 

68. Cysticerus lodged under the Conjunctiva. — Dr. Hcering, of Luisburg, re- 
lates a case in which a cysticerus cellulosus of the size of a pea, existed under 
the conjunctiva at the external angle of the eye. The patient, a girl of seven 
years, had hurt the eye against the edge of a tub. Dr. H. thinks that the de- 
velopment of the hydatid is to be ascribed to this hurt. — Journ. des Com. Med. 
Churg., Dec. 1841. 

69. Cataract suddenly formed in both Eyes. — Dr. Martin of Portlaw commu- 
nicated to the Surgical Society of Ireland, (April 16th, 1842,) the following 
example of this very rare occurrence. 

" Mary Grant, aged 35, of a miserable cachectic habit, after sitting up for seve- 
ral nights with her invalid mother, suffering much bodily and mental distress, 
and crying a great deal, fell asleep in the sitting posture, by the fire-side, at 
about twelve o'clock, on the night of Friday, October 15, 1841. About four or- 
five o'clock she awoke, and (although her vision was before perfect) she then 
found herself unable to distinguish any object around her, and when the clearer 
light of day came, she was but able to trace the outline of the window sash. Hav- 
ing applied to me for advice, three days after, I was surprised on examination 
to find the lens of both eyes semiopaque, and presenting the appearance of being 
starred from the centre, as if breaking up during maceration. She complained 
of severe pains in the forehead, jaws, and shoulders — pulse 80, full and hard — 
tongue loaded with white fur — bowels confined. By means of blue pill, bitters, 
and blisters to the temples, the pains were removed, and her general health im- 
proved, but the lenses gradually became more opaque, and she is now unable 
to trace outlines of objects passed before her eyes, although the retina is per- 
fectly sensible to the impression of light. That she had perfect vision up to the 
night on which she states she became blind, 1 feel perfectly satisfied, as on that 
evening having been in attendance, I saw her moving about, and nurse-tending 
her mother, and I had seen her frequently during the previous month." 

Dr. Martin also stated that he remembered, when a pupil, to have seen a some- 
what analogous case. The man was a patient in Sir P. Dunn's Hospital, and 
the following was the history which he gave: he said that he had beem married 
to a farmer's daughter, and after the usual fun of an Irish wedding, he retired 
to bed, his sight being perfectly good. Very early in the morning he was called 
by the necessities of nature to the outside of the house, when he became con- 
scious of the loss of sight. Fearing the ridicule of his friends he made his way 
into the house to where his clothes lay, which he found with some difficulty, 
and left his bride to wonder at his loss for the next two months. He came up 
to Dublin, and was admitted into Sir P. Dunn's Hospital, where he was suc- 
cessfully operated on by Dr. Jacob. I need not add that his story was laughed 
at and disbelieved at the time; but I have little doubt now, that it was analo- 
gous to that of Mary Grant. In his case also, as in that of Mary Grant, the 
blindness was not complete at once; in the end, however, both lenses became 
densely opaque. — Lublin Med. Press, May 4, 1842. 



MIDWIFERY. 

70. Extra-uterine Pregnancy. — A woman, 70 years of age, was admitted into 
the Hospital Cochin, under the care of M. Blache, for an abdominal tumour, 
which she had had for thirty years. The tumour, which occupied the left iliac 
fossa, was large and hard; it had latterly become very painful; the abdomen was 
tense, and painful to the touch; and the lower extremities oedematous. She died 
of peritonitis in September last. On examination of the body, the tumour was 
found to consist of the remains of a full-grown foetus, almost all the bones being 
connected together by incomplete ligaments, and forming a complete skeleton 
twisted on itself. The pelvis and lower extremities were the back part of the 
tumour, the occiput in front. The head constituted at least two-thirds of the 
whole mass. This poor woman considered that this tumour showed itself when 



21^ Progress of the Medical Sciences, [Juty 

she was forty years old; she ceased to menstruate at fifty, having previously 
borne one child at the age of seven-and-twenty. — Frov. Med. and Surg. Journ., 
May 28ih, 1842. 

71. Number of Pulsations of the Fvetal Chord. — Mr. Streeter stated that he has 
recently met with a case of prolapsus of the funis, at that stage of labour when 
the OS uteri was scarcely larger than a shilling; he took the oportunity of verify- 
ing the number of pulsations of the fostal chord, and of ascertaining whether Dr. 
Hamilton's statement respecting the slow pulse of the foetus was correct; he 
found the mother's pulse to be under 100, whilst that of the foetus was 120. 
The chord was coiled; he drew it down, but it retracted; this he repeated several 
times, and always with a similar result. He endeavoured to return it within the 
OS uteri, but was unable to do so. The dilatation of the os uteri progressed 
slowly, the pulsation in the chord ceased, and the child was born dead. 

72. Rupture of the Womb during Gestation — Recovery. — Dr. Richter relates 
an example of this occuring in a Moravian peasant, 20 years of age, who, while 
crossing a bridge in April 1840, when in the ninth month of pregnancy, was sud- 
denly seized with a fainting fit, which lasted a considerable time. Upon recover- 
ing from it, she complained of great pain in the lower part of the abdomen, with 
violent motion of the infant. This latter continued for twenty-four hours, and the 
former, with more or less intensity, for four weeks. The fever then subsided, 
and she was enabled to rise. On the 18th of June, a quantity of very fetid pus 
escaped from the vagina, the uterus and abdomen seemed to diminish in size, 
and the motions of the child ceased completely. In the beginning of July, the 
integuments round the umbilicus became inflamed, and ulceration took place, 
giving vent to a greenish yellow fluid, similar to that which was passed from 
the vagina. Some days subsequent to this, the patient felt a hard body in the 
vagina, which she extracted, and which was found to be a bone, about two 
inches long, and about the size of a crow quill. On the 15th of July, Dr. 
Ritcher was consulted. She had then all the symptoms of hectic fever; the 
abdomen was painful on pressure, and on the left of the umbilicus, which was 
ulcerated to about a quarter of an inch, was felt a round hard tumour. A bone 
was discovered firmly wedged in the mouth of the uterus; tepid water injected 
into the vagina escaped by the opening in the abdomen. Several bones of the 
extremities of a foetus were extracted, and frequent injections of warm water 
were had recourse to. The patient's general health became much improved. 
Towards the end of August another fistula took place below the umbilicus, into 
which it soon opened. A slough having separated from this, a hard body was 
felt, which, upon being removed, was seen to be the scapula. The remains of 
the foetus were then taken away by degrees. The intestinal canal had been per- 
forated by the ulcerative process, as fecal matter escaped both from the fistulous 
opening and from the vagina. On the 13th of October the discharge had ceased. 
She gained strength rapidly, and was soon able to follow her domestic employ- 
ments. — Lond. and Edin. Monthly Journ. Med. Sci., Feb. 1842, from Gaz. Med. 
de Paris, Oct. 2, 1841. 

73. On the Management of the Placenta. — Mr. Joseph Bell relates, in the 
London Medical Gazette (Jan. 14th, 1842), a number of cases to prove the efficacy 
of a mode of managing the placenta, recently recommended by Mr. Murphy. 
It is chiefly applicable to cases where it is usually thought necessary to intro- 
duce the hand for the purpose of extracting the placenta, and consists in the ap- 
plication of a broad bandage round the abdomen, and firm pressure made with 
both hands on the fundus uteri. The same practice he has also found of use 
previous to delivery, in cases of inefficient pains. Mr. Bell seems strongly op- 
posed to the practice of introducing the hand into the uterus to extract the pla- 
centa, under any circumstances, and while he admits that there are cases of re- 
tained placenta, in which the above measures are attended with very little 
benefit, recommends that in them the child should at once be put to the nipple 
as a preferable course to the usual practice. This, he says, has always been 



1842.] Midwifery, 213 

followed by uterine contraction, cessation of the flooding-, and expulsion of the 
secundines. — Land, and Edin. Monthly Journ. Med. Set., May, 1842. 

74. Fads relative to the statistics of Menstruation, — The following results have 
been obtained by different observers. 

Petrequin, from 272 cases noticed in France, gives the period of its appearance 
as follows: 

In 4 at 10 years of age In 27 at 18 years of age 

10 at 11 12 at 19 

15 at 12 7 at 20 

33 at 13 5 at 21 

33 at 14 1 at 22 

45 at 15 

48 at 16 272 

32 at 17 
Hence, the period at which it generally occurs in France, is between 13 and 
15 years of age. 

He also fixes the period of cessation at between the 35th and 55th years. 
From a comparison of 60 cases, it appears that the discharge ceases between 
35 and 40 years of age, in about one eighth; between 40 and 45, in one quarter; 
between 45 and 50, in one half; and between 50 and 55, in one eighth of the 
whole. — Medico-Chir. Rev. from Bull. Med. Beige. 

Dr. Adelmann of Fulda in Germany, ascertained the period at which men- 
struation had commenced in 507. According to him, the average age in girls 
with black hair was 16; in those with brown, it was 17, and in those with fair 
hair, between 16 and 17. The average duration of each menstrual period, was 
four or five days for the black haired, and four for each of the others. Only one in 
102 cases was met with who menstruated regularly at the interval of three 
weeks: all the rest did so at regular periods of four weeks. — Edinburgh Med, 
and Surg. Journ. from Neue Zeitschrift fur Geburtskunde. 

The researches of Brierre de Boismont have been more extensive than either 
of the foregoing. 

As to the first appearance, of 276 women living in the country, the mean age 
was 14 years 10 months; of 205 living in towns, 14 years 9 months; and of 
359 either born in Paris, or who lived there at least a year prior to menstruat- 
ing, the mean age was as follows; in 171 poor women, 14 years 10 months, 
which agrees with Marc d'Espine and Bouchaconrt's statements; in 135 of the 
middling classes, 14 years and 5 months; in 32 girls in M. Bouvier's Orthopce- 
dic establishment, 14 years 8 months, and in 53 of the highest ranks, 13 years 
7 months. Chomel, Andral and Recamier, likewise fix the age for commencing 
menstruation, among the upper classes, at between 12 and 14. The average 
age obtained by the union of 359 of all classes, in the capital, is 14 years 6 
months. Marc D'Espine places the mean figure in Paris at 14.965. It is at 
Manchester, 15.191, and at Marseilles and Toulon 14.015. Of 652 women, 63 
have never menstruated regularly. The period of return is generally 28 days, 
but in a great number examined, 30 days were found to intervene. The dura- 
tion appears to be very irregular. Of 562 women, it continued: 
In 172, 8 days In 21, 6 days 

119, 3 days 12, 7 days 

78, 4 days 17, about 9 days 

62, 2 days 

46, 5 days 562 

35, 1 day 
The menses continued longest in the inhabitants of the city, and the nervous 
and indolent. — Medico-Chir. Rev. April 1842, from the Memoirs dc rAcademie 
Roy ale de Medecine. T. R. B. 

75. Extraordinary Birth. — Dr. Schnackenberg relates in the Neue Zeitschrift 
fur die Geburtskunde, a case in which a dead child was born, the head, right 



214 Progress of the Medical Sciences. [July 

foot, left hand, and umbilical cord, all presenting at once. The right parietal 
bone of the head was applied against the piibes of the mother; the left was 
turned backwards, with the sole of the right foot resting on it; this latter being 
covered by the left hand, the back of which lay against the hollow of the 
sacrum. When arrived at the vulva, the left hand was protruded before the 
head; the body of the foetus, after its birth, preserved the same position as it had 
in the womb. — Prov. Med. and Surg. Journ.^ May 14th, 1842. 

7G. Msfradion of the Uterus after delivery. — In our No. for August 1839, will 
be found an account of two cases in which the uterus was dragged away by 
ignorant mid wives, and two other examples of the same horrid transaction are 
there alluded to, and we have now to add to this catalogue of atrocities, a fifth 
example, related by Dr. Peracchi in the Annali Univ. di Medicina. The sub- 
ject of this last case, Rosa Gazzola, 38 years old, was attended in her fifih con- 
finement, in 1837, by a soi-disant sage femme. She was well delivered, but after 
the expulsion of the placenta, she suffered from intense uterine pains, and a feel- 
ing of weight in the vagina. The midwife examined her, and stated that these 
pains were caused by the presence of another child in the uterus. In pursuance 
of this opinion, she introduced her hand into the vagina, said she felt the child, 
seized it, and made great and forcible traction. The patient felt that she was 
being lacerated; four strong men were holding her, while the midwife continued 
her efforts at traction. At last, after unheard-of efforts, the pretended child was 
dragged out of the vagina, and the midwife remarked that the nates were born, 
the rest of the body was behind. In order to aid her efforts, she wrapped up 
the protruded portion tightly in a handkerchief, and continuing to pull, she finally 
tore away the entire uterus from the body of the unfortunate mother. 

Dr. Peracchi, who was sent for, found tremendous hemorrhage, and the pa- 
tient constantly fainting. She appeared like a corpse, the pulse could not be 
felt, a large quantity of the bowel protruded through the vulva, and the vagina 
was full of coagula of blood. The doctor was much alarmed at the state in 
which he found the unhappy sufferer, and still more so when he ascertained the 
womb had been torn away. He returned the bowels, raised the pelvis, &c., and 
had recourse to cordials; the patient gradually revived; fever set in, requiring 
bleeding, &c.; and the poor woman finally recovered. 

At the period when the catamenia should be present, Gazzola su-ffers from 
general prostration, oppression, vomitings, headaches, and abdominal pains. Her 
hair has fallen, the face is pale, the muscles thin and, as it were, atrophied; the 
voice is harsh and disagreeable; speech difficult. The vulva is natural, the 
vagina about three inches long, and terminating by a thin yielding cul-de-sac. 
At the antero-superior part of the canal is an irregular, hard, and painful cica- 
trix, about an inch and a half long. The urine and fasces pass with difficulty 
and pain. The examination of the organ showed it was completely torn away, 
together with the Fallopian tubes and broad ligaments. 

The midwife was proceeded against criminally, and sentenced to one month's 
imprisonment and a small pecuniary fine. 

77. Polypus of the Uterus expelled by the action of Secale Cornutum. — M. P. 
MoYLE was requested to attend without delay a Mrs. W., who had suddenly 
lost a large quantity of blood from the womb, and had just recovered from a 
long state of syncope. The blood was lost in about two or three minutes. She 
had frequently had small hemorrhages previously, and was becoming weaker in 
consequence. Her legs and thighs were swollen almost to bursting, her coun- 
tenance pallid, respiration difficult, and general health decaying. After she had 
recovered greatly from her fainting, and after Mr. Moyle had satisfied himself 
that the flooding was owing to polypus of the uterus, he proceeded as follows: 

"A fresh appearance of hemorrhage induced me to give her at once two 
drachms of the tincture of secale cornutum, the valuable effects of which I had 
often before experienced. I also applied a bandage firmly round the abdomen, 
and applied cloths, wetted with cold vinegar and water, to the pudendum. The 



i 



1842.] Midwifery. 215 

discharge proved to be little, and no faintness followed. In twenty minutes 
after the first dose, the tincture was repeated, and in a few minutes she com- 
plained of being- griped. Suspecting this griping to be a slight contraction of 
the uterus, I ventured an examination by the vagina. The vagina was full of 
coagula; the os uteri was flabby and dilated to the size of half-a-crown piece, 
immediately within which I found a substance of somewhat firmer texture than 
the coagula, and around which my finger passed freely. During the examina- 
tion there was a pain of sufficient force of the os uteri to embrace the finger 
firmly, and I now felt confident of being able to subdue the hemorrhage for the 
present, and was not without hopes that I might, by a perseverance of the 
remedy, enable the uterus to throw off the extraneous substance within it. A 
third dose was now administered, which kept up the pains at short intervals, 
but they were weak and feeble. Finding this the case, the supposition was, 
that she was too much reduced from the disease and the recent loss of blood for 
the medicine to have its full eflect. A cup of gruel, with a small quantity of 
brandy in it, was given her, and in a half an hour after, another similar potion, 
which had the effect of reviving her to a great degree. I now took my leave 
about eight o'clock P. M., giving directions for a repetition of the food, together 
with some beef-tea, at intervals of an hour or every second hour, leaving with 
her four doses of the secale, to be taken at intervals of half an hour; in case 
there should be the slightest appearance of flooding, I was to be sent for imme- 
diatey. 

"Early on the following morning, I found her labouring under sharp contrac- 
tile pains of the uterus, from having taken, two hours previously, two doses of 
the secale. Examination discovered the mass of polypus filling the vagina. 
The patient was very cheerful, and expressed herself convinced that the mass 
was coming away. The pains were by this time not so severe as they had 
been, and consequently, I now gave her three drachms of the tincture in a little 
brandy. This had the effect, in about twenty minutes, of producing a severe 
pain, which brought the mass to the os externum. It was now grasped with 
the hand, and, on the recurrence of the pain, the whole was discharged. Slight 
hemorrhage only followed the expulsion of the polypus, which equalled in size 
two large placentae. From this moment she recovered with great rapidity. 
There was a slight appearance of the menses at the end of six weeks, succeeded 
by a more abundant appearance at the termination of another similar period. 
She daily improved in health, the oedema gradually subsided, and although she 
was for many months unable to put the whole weight of her body on her right 
leg, yet from bandaging, the use of tonics, &c., she is now, in all respects, a 
perfectly healthy robust woman." 

[The successful result of this case induced Mr. Moyle to try the use of the 
ergot in another patient who had previously been under his care. He visited 
her on the 7th Sept. 1.839, and gave her four doses of the tincture of secale cor- 
utum, 3ij. in each dose. Two or three slight pains were now experienced, 
nausea and vomiting followed. Shortly afterwards she had a severe labour 
pain. She then took §iij. more of the tincture, and the pains increasing, the 
polypus mass was felt at the os uteri. By the further use of the medicine, the 
substance was completely expelled. It was about the size of an average pla- 
centa. 

'J'he following case related by Dr. Somerville will corroborate the statements 
of Mr. Moyle.] 

" Mrs. G., aged 26, had been subject to femoral hernia of both sides for seve- 
ral years, and for some time previous to her marriage, up to the period of her 
first confinement, had suffered much from leucorrhoea. At the time of her de- 
livery, she had an attack of uterine hemorrhage, which subsequently returned 
at intervals, and continued with considerable violence, till she called on me for 
advice, about fifteen months after her delivery. I did not, at that time, propose 
an examination, but prescribed a few doses of ergot in powder. The next day 
she complained of being severely pained, since she had taken the powder; and 
the discharge still continuing, I examined the state of the uterus, and found a 



216 Progress of the Medical Sciences, [J"^y 

mass slightly protruding through the os uteri, which I believed to be a polypus. 
The ergot was given in increased quantity, and at shorter intervals, which pro- 
duced severe bearing-down pains, and in a short time, a polypus about the size 
of a large orange, having a thick pedicle, and attached to the anterior surface of 
the cavity of the uterus, was propelled into the vagina. After an interval of a 
few days to permit the irritability of the uterus to subside, a ligature of silver 
wire was applied by means of a double canula, but it broke on being tightened. 
Another and stronger wire was applied, and after it had been firmly tightened, 
great pain and tenderness of the tumour, and also of the abdomen supervened. The 
abdominal tenderness was speedily relieved by antiphlogistic means, but the 
pain and uneasiness of the tumour still continued, in such a degree, as to require 
great gentleness and caution in tightening the ligature. The wire, however, 
gradually ulcerated through the portion to which it was applied. On its sepa- 
ration, the lower half of the pedicle of the tumour was found divided, while the 
upper half, which probably had been first separated, had become reunited, and 
a distinct sulcus was felt on its upper surface, where the reunion had taken 
place. The circumstance of the time required for tightening the ligature being 
considerably longer than usual, on account of the tendency to abdominal in*- 
fiammation and the tenderness of the mass itself, will probably account for this 
unusual occurrence. The polypus became gradually smaller, and the pain in it 
having abated, another ligature was applied in the same site, which, in a very 
few days, effected a complete separation of the tumour, and it was removed by 
the fingers. On inspecting the polypus, the sulcus, where the second ligature 
had been applied, and reunion had taken place, was perceived extending all 
round the upper half of the pedicle. The uterus was examined by the speculum 
shortly after; — the os uteri was still open, and its lips swollen and tender, but 
these symptoms were speedily removed, and the woman is now in the enjoy- 
ment of excellent health. 

Dr. M'Farlane, in his Essay on Polypus of the Uterus, in the Glasgow Medi- 
cal Journal for 1828, mentions the following case, where the effect of the secale 
cornutum was equally decided, and the separation of the tumour was effected 
without the use of any other means, as in those ef Mr. Moyle. 

A lady, who had been subjected to profuse hemorrhage for a period of ten 
months, had for several years been affected with habitual leucorrhcea. After 
various remedies had been employed without effect, an examination was made, 
and the uterus felt enlarged. Considering that the continued hemorrhage might 
be owing to the presence of a polypus, or some other tumour within the uterine 
cavity, Dr. McFarlane resolved to try the effect of the ergot of rye, as, from the 
character of the lady, and the history of the case, he had no reason to suspect 
pregnancy. After the administration of some doses of this medicine in infusion, 
severe pains were produced, which continued for several hours, when, on exa- 
mination, a polypus was found in the vagina, having a slight pedicle, which in 
a few days ulcerated, and was easily extracted. — Braithwaite's Retrospect, No. 
IV, from Lond, and Edin. Monthly Journ. Med. Sci., June and August, 1841. 

78, Pregnancy unattended with the usual signs, and in tvhich parturition oc- 
curred without labour-pains: rupture of the funis which remained untied forty- 
jive minutes. By Thomas Lewis, Esq., Liverpool. — A lady, aged 31, had no- 
ticed an enlargement in the abdomen for six or seven months. She felt certain 
she was not pregnant, because she had not experienced symptoms similar to 
those of her first pregnancy. Catamenia appeared last eight or nine months ago. 
External examination not proving satisfactory, examination per vaginam was 
made, which disclosed the nature of the case. The os uteri was dilated to the 
size of a shilling, the neck entirely expanded, and the membranes and child's 
head could be felt. Though informed she was pregnant she was sceptical, and 
made no preparation for the event. On the 5th of January the author was 
sent for, and found the child born before his arrival. The funis was ruptured 
about four inches from the umbilicus. It appears the lady had suffered from 
diarrhoea for two days previous. At one o'clock in the morning she awoke with, 



1842.] MedicalJurisprudence and Toxicology. 217 

she says, griping pains in the belly. These continued until six o'clock, when 
she got out of bed for ease. She walked into an adjoining room, and bending 
herself rested her hands on a table. Suddenly the waters broke, and the child 
was expelled, and fell on the floor. She states positively she had no pains in 
the loins nor hearing-down pains previous to the expulsion of the child. — Lancet, 
May 21, 1842. 



P 



MEDICAL JURISPRUDENCE AND TOXICOLOGY. 

79. Guerard on the consequences of drinking cold liquids when heated. — The 
author has been induced to examine this subject, as well in consequence of the 
frequency and fatality of accidents from the above cause, as from the suspicion 
of poisoning to which they have given rise. 

Whilst dangerous, and even fatal effects from drinking cold liquids, when the 
body is heated, have long been noticed, the nature of the injury induced has 
remained in doubt. M. Guerard refers this to several causes — injuries of in- 
nervation — affections of the digestive apparatus, and affections of the circulat- 
ing system. 

The nervous symptoms are violent local pains, trismus, various spasmodic 
phenomena and sudden death. Those of the two last classes, are inflammations 
of the digestive and circulating systems. 

In illustration of the first cause assigned, Guerard asserts, that every species 
of cold liquid, (wine and beer, as well as water,) will produce these dangerous 
eflTects, if taken when the body is heated by exercise or violent passion, and fur- 
ther that it is not the coldest liquids that will cause this, but those having the 
ordinary temperature of cellars, viz., about 53*^ of Fahrenheit. So far as cases 
have come to his knowledge, liquids of this temperature most certainly induce 
a fatal termination, and not those cooled down to zero or below it. 

If this be correct, we are not warranted in ascribing these fatal results to a 
purely physical cause. The heat of the body, even when highly excited by a 
warm temperature, violent exercise, and even disease, is at its greatest possible 
maximum at 107° (42° centigrade) and a glass of water at 53°, drunk under 
these circumstances, causes death. But on the other hand, if the body be not 
heated, we can drink water cooled down to 32° in winter and even spring, with 
impunity, although the animal heat be 98°. A difference in the former case of 
only 54°, whilst in the latter, it is 66. 

This diversity is, according to our author, to be explained by the fact, that in 
the former case, the temperature has been excited beyond its natural limit, and a 
corresponding result has thus been induced in the vital properties, and more par- 
ticularly, in the sensibility. 

Among the remarkable cases, mentioned by M. Guerard, explanatory of the 
second cause, is that of a bookbinder in Edinburgh. This person, enjoying ex- 
cellent health, arose at six in the morning, to light his fire, and then drank a 
large tumbler of cold water from a pitcher. He returned to bed, and was imme- 
diately seized with a violent pain at the pit of his stomach. To this, after 
intense sufferings, succeeded vomiting, which could not be checked. Death 
took place in eleven hours, and on dissection, no appreciable lesion could be dis- 
covered. 

Here are conditions analogous to those noticed under the first head. The body 
■was warm from the heat of the bed; the stomach empty. The water cooled 
down to the temperature of the room, and probably near zero, and drank sud- 
denly. 

In other instances, the result has been gangrene or dropsy. A Marechal de Loyis, 
carrying a despatch in great haste on a very warm day, took a single draught from 
a bottle of beer that stood in ice. He died in consequence in five days, and the 
stomach was found inflamed and gangrenous. It is remarkable, that liquids less 
cold cause death instantaneously. M. Guerard endeavours to explain this vari- 
No. VII.— July, 1842. 19 



218 Progress of the Medical Sciences. [July 

ance, by their different effects on the nervous extremities distributed over the 
mucous coat. In the first case, the ice cold liquids paralyze as it were the ner- 
vous filaments, and the impression received by them is not communicated to the 
cerebro-spinal centre. In the last, the constriction is less considerable, and the 
impression on the nervous organization is transmitted to the whole system. 
Thus, the disorder, vi^hich, in the former case, was confined to the stomach, is 
now by the action induced, a general one. 

As to the third division, viz. the effects on the circulating system, M. Guerard 
adduces several instances of haemoptysis, caused by drinking cold water, when 
the body was heated, and in a state of profuse perspiration. The following also 
illustrates the medical jurisprudence of former days. The dauphin, son of 
Francis the First, whilst heated and perspiring from playing tennis, drank ^a 
glass of cold water. He died, in consequence, of pleurisy, which supervened. 
Soon the cry of poisoning was heard throughout France. The count Montecu- 
culi, cup-bearer to the prince, was put to the torture, and in his agonies confessed 
that he had added arsenic to the water. He was drawn asunder by four horses. 

Pneumonia is a frequent consequence of imprudence in the use of cold 
water. 

In conclusion, the author recapitulates the conditions which induce these 
grave accidents; the previous heating of the body; an empty condition of the 
stomach; the great quantity of drink swallowed at a draught; and lastly, and 
of less importance than any of the former, the temperature of the fluid. In ad- 
dition to the facts already mentioned, he urges the circumstance that ice never 
causes such fatal terminations. 

The emptiness of the stomach must accelerate the result, since the liquid 
comes in direct contact with the mucous coat. So also, if a large quantity be 
swallowed, it reaches a large portion of the surface. Ice, on the contrary, as 
it melts slowly, can only produce a limited effect. — Bulletin of the Royal Jlca- 
demy of Medicine^ sitting of January 25, 1842. T. R. B. 

80. Detection of Arsenic acid hy M. Eisner. — (Translated from the Annales 
Des Mines, by Professor Griscom.) It is well known that M. Runger disco- 
vers free sulphuric acid by covering a porcelain desk with a solution of one part 
of sugar and thirty parts of water, heating the dish by exposure to steam till it 
acquires the same heat, and then dropping on it the liquid supposed to contain 
the free sulphuric acid. A black colour indicates the presence of this acid, be- 
cause the greater number of other free acids do not decompose the sugar in 
this manner. 

1 have found that arsenic acid acts in a peculiar manner, producing on the 
porcelain coaled with sugar, a beautiful scarlet red colour. The reaction is sen- 
sible with a liquid containing only -,-^l^ of arsenic. The action of arsenic acid 
produces on the sugar, ulmic acid, which brings the former acid to an inferior 
degree of oxydation. — Journal of the Franklin Institute, February, 1842. 

T. R. B. 

81. On spots in glass resembling those of Marsh, produced by a reducing fame. — 
Professor Louyet, at a previous meeting, stated that he had obtained by means of 
acurrent of hydrogen gas, metallic spots in certain glass vessels, greatly resem- 
bling those produced by the apparatus of Marsh, from arsenic. He was, how- 
ever, unable to explain the cause, since on analysis no arsenic could be detected 
in the glass. By subsequent experiments, he was satisfied that they were owing 
to the presence of lead in the glass itself, and he ascertained this in the follow- 
ing manner. Three grammes of the glass powdered, were melted with four 
times their weight of carbonate of potash, in a platina crucible. The substance 
obtained was then treated with boiling diluted nitric acid and the liquid evapo- 
rated to dryness. This was again dissolved in boiling water, and filtered anew, 
in order to separate a portion of silica. On adding an excess of potash in solu- 
tion, a gelatinous precipitate was obtained, which was collected on a filter, 
washed and then dissolved in nitric acid. Liquid bichromate of potash caused 



1842.] Medical Jurisprudence and Toxicology. 219 

a yellow precipitate when added to this solution; a plate of zinc, a metallic 
crystallization, and sulphuret of ammonia, a black precipitate. 

The remainder of the acid solution was submitted to a stream of sulphuretted 
hydrogen: and the black precipitate thus obtained, after beincr washed, and pro- 
perly dried, was mixed with a portion of black flux and reduced. A metallic 
substance was the result which proved to be pure lead. — Bulletin of Ike Royal 
Academy of Sciences of Brussels, vol. 8, May, 1841. T. R. B. 

82. Do Metallic poisons when mixed with cultivated land^ enter into the compo- 
sition of the vegetables produced? — We mentioned in the last number, that this had 
been proposed as a prize question by the Academy. Five memoirs were re- 
ceived in reply, three of which came too late. To the others, the Academy 
awarded silver medals. 

The first (written by M. Louyet, Professor of Chemistry in the Central 
School of Commerce and Industry at Brussels) stated that the author had impreg'- 
nated a portion of soil with arsenic in three different proportions— also a part 
with arsenite of potash — with tartrate of potash and antimony — with sulphate 
of iron — sulphate of copper — sulphate of zinc — proto-nitrate of mercury — and 
corrosive sublimate. In these, barley, rye, and buckwheat were sown. When 
the quantity of arsenic in a square of 64 feet of ground, amounted to 1280 
grains, germination was checked, but when the quantity in the same space was 
more than 256 grains, neither it nor the full growth of the plants was at all re- 
tarded. The roots, leaves, and seeds of the cereals thus produced, were mace- 
rated in a gentle heat for two or three days with a solution of caustic potash. 
This after being concentrated and neutralized with sulphuric acid, was intro- 
duced into the apparatus of Marsh. No indication of arsenic was perceived. 
The author then examined a portion of the above soil, and found in it, a sensible 
quantity of arsenious acid in a soluble state. It would thus seem, that although, 
the cereals grow in a soil impregnated with arsenic, yet their roots do not im- 
bibe an appreciable portion of it. Mr. Martens, the reporter on this memoir, 
however regrets that the author did not employ the method of carbonization 
with nitric acid, as much the most certain for detecting minute portions of 
arsenic. 

When the grains, which had been checked in their growth by the too strongly 
impregnated soil, were submitted to analysis, they were found to contain a sen- 
sible quantity of arsenious acid, thus proving that the absorption of the poison 
had checked vegetation. 

No poison could be detected in plants grown on the soil containing arsenite 
of potash, but the author ascertained that this salt was almost entirely insoluble, 
having been mainly converted into an arsenite of lime. 

A similar result was obtained with plants from the soil containing tartar eme- 
tic. This salt had also become insoluble. 

Iron in notable quantities was detected in every part of the plant, grown on 
the soil impregnated with sulphate of iron, thus apparently proving that non- 
poisonous substances are more readily absorbed than their opposites. So also 
with plants grown on the soil containing copper. That metal was detected in 
the leaves, twigs and seeds, while on the contrary, no trace of it could be disco- 
vered in cereals growing on soil not impregnated. 

In plants from the ground containing sulphate of zinc, proto-nitrate of mercury 
and corrosive sublimate, no trace of these substances could be discovered, nor 
did they appear to have influenced or retarded their growth. When, however, 
.plants were watered with a strong solution of corrosive sublimate, they died in 
a few days, and on analysis, the poison was detected. 

The conclusion of the author from these experiments is, that a soil containing 
a notable proportion of metallic poison will not check or impede the growth and 
maturity of cereals. 

The second memoir was written by M. Verver, of the University of Gronin- 
gen. He also had divided off a garden plot into various squares and impregnated 
the earth in each with the respective poisons. The results with arsenic were 



220 Progress of the Medical Sciences. [July 

precisely similar to those of Louyet. He did not detect any copper in the vege- 
tables raised from that soil, but this is ascribed to the insufficiency of the analy- 
sis, and probably somewhat also to the decomposing effect of the carbonate of 
lime in the earth, on the sulphate of copper. 

M. Verver also planted balls made of the mixture of the grain and of arsenic; 
(as is frequently done by farmers;) vegetation was not in the least impeded; the 
plants did not contain the poison, although it was detected in a soluble state in 
the soil several months thereafter. 

A similar result occurred when arsenic and arseniate of potass in powder were 
inserted at the root of growing plants, but watering them with a solution of the 
above substances speedily induced death. 

From these results, our author is induced to believe that the practice of farm- 
ers, of scattering arsenic over their cultivated grounds, in order to destroy nox- 
ious animals, cannot prove injurious to the cereals growing in them. 

The examiners of the above memoirs seem notwithstanding inclined to dis- 
suade from the use of this dangerous material. — Bulletin of the Royal Academy 
of Brussels, vol. 8, May, 1841. T. R. B. 

83. Superfoiiation. — Mr. Renauldin presented to the Academy a two-lobed 
uterus, of which the following was the history. A female, aged 23 years, six 
months advanced in pregnancy, aborted. After suffering severe abdominal pains 
for a week, she was admitted into the Hospital Beaujon. M. Renauldin found 
her labouring under the most marked symptoms of puerperal peritonitis, and 
she died in seven days thereafter. 

On dissection, the external organs and the vagina were found to be natural, 
but the uterus had a double neck, and was divided into two cavities completely 
separated from each other, with an ovary, fallopian tube and ligaments to each. 
The left cavity, much larger than the right, still contained some bloody spots, 
and from this the foetus is supposed to have proceeded. With such an anato- 
mical conformation, it is supposed that superfcetation might have occurred. 

The present is a proper place to mention that I have read with pleasure the 
article ^''Generation''' by Dr. Allen Thomson in the "Cyclopedia of Anatomy 
and Physiology." In his remarks on Superfcetation, he has however, commit- 
ted one error of some importance, viz., increasing incorrectly the number of 
extraordinary cases. The first is quoted from Burdach, and related on the 
authority of Eisenmann. The fifth is quoted from Velpeau, and is related of a 
Madame Bigaux. Now these are one and the same case. Madame Bigaud 
Vivier on the 30th of April, 1748, was delivered of a living child, and on the 
16th of September succeeding, another of full size and mature was born. The 
mother, who had also a child in 1752, died of an acute disease in 1755, and was 
examined by Prof. Eisenmann, who found the parts natural. There was no double 
uterus. My authority for this is Devergie, Medecine Legale, vol. 1, p. 489, 1st 
edition. Desgranges' case is equally reriiarkable with the above, but in this 
there was no dissection. 

The following remarkable case is quoted in the British and Foreign Quarterly 
Review of October, 1841, from the communications of a Society of Physicians 
practising at Riga. "A robust girl conceived in February, and in consequence 
menstruation ceased. In June, she aborted. To her dismay, soon after the 
symptoms of advanced pregnancy appeared, and in the beginning of November, 
five months after the abortion, she was delivered of a full grown child, which 
doubtless, was the result of the same impregnation, as the foetus expelled at the 
fourth month." — Bulletin of the Royal Jlcademy of Medicine of jfaris^ sitting 
of the 21st of December, 1841. T. R. B. 

84. Plea of Quick with child in criminal cases. — At a meeting of the Provin- 
cial Medical and Surgical Association, held in August last at York in England, 
the following resolution was moved by Mr. Griffiths of Wexham, and carried. 

'' The attention of this Association having been called to the present state of 
the law as it affects female criminals under sentence of death, it desires to re- 



k 



1842.] Medical Jurisprudence and Toxicology. 221 

cord its strong feelings of repugnance to a statute, which permits the woman 
who has quickened, to plead pregnancy in bar of execution; whilst the same 
individual, though equally the mother of a living child, but not having quick- 
ened, must suffer the extreme penalty of the law; thus making a distinction 
where there is no difference, and fatally, though ignorantly, sacrificing an inno- 
cent life with that of the guilty parent; and though not prepared on the present 
occasion to take any decided steps, the Association fully recognises its obliga- 
tion to adopt at some future time such measures as will, it trusts, lead to the 
abrogation of a law, cruel in its effects, inconsistent with the progress of know- 
ledge and civilization, and consequently revolting to the feelings and claims of 
humanity." — Edinburgh and London Monthly Journal of Medical Science, Sep- 
tember, 1841. T. R. B. 

85. Presence of Lead in the solids and fluids. — In a case at King's College 
Hospital, London, treated by Dr. Budd, where the patient had been a house 
painter for five years, and died from colic and epilepsy, ihe metal was detected 
in the brain by chemical analysis, " but Mr. Bowman could obtain no evidence 
of it by the microscope." This examination appears to have been made, from 
the fact stated, that in two cases observed by Devergie and Guibourt, in which 
lead was detected in the brain, the white matter of the organ examined under 
the microscope by M. Gluck, was'said to be remarkably altered in its minute 
structure. 

Dr. Budd presents the above case as an illustration of the continued effects 
of lead on the system. It remains in it. The poisonous preparations of lead 
do not pass off, or at least very sparingly, in the secretions. " In this respect, 
they form a striking contrast with iodide of potassium. When the latter accu- 
mulates in the blood, it produces sneezing, watery eyes, headache and a variety 
of other symptoms, but it passes off readily in the urine and other secretions, 
and at the end of two days, if no more of the medicine be given, the symptoms 
vanish. The poison of lead, on the contrary, remains in the system, and its 
effects are consequently lasting." 

The fact that acetate of lead has been lately detected in the urine, confirms 
the idea that it is the least poisonous of the salts of this metal. 

*' It is stated by M. Liebig, in his work on Organic Chemistry, that sulphuric 
acid lemonade— a solution of sugar rendered acid by sulphuric acid— is a pre- 
servative from the injurious effects of lead; and that colic is entirely unknown 
in all manufactories of white lead, in which the workmen are accustomed to 
drink iU^— London Medical Gazette, December, 1841. T. R. B. 

86. ChevalUer on a new mode of distinguishing arsenical spots from antimonial 
spots. — M. BiscHOFF, a Saxon, mentions in the Fharmaceutisches Centralblat, No. 
26, a mode of distinguishing arsenical spots produced by the apparatus of Marsh, 
from those of antimony. It is founded on the property possessed by the chlo- 
rite of soda {liquor of Labarraque) of dissolving the arsenical ones, whilst it 
does not affect the others. 

Being desirous of ascertaining the value of this test, M. Che vallier, associat- 
ing with himself M. Labarraque, prepared on various capsules I. spots of 
arsenic; 2. spots of antimony; and 3. spots of antimony and arsenic; and they 
found that the arsenical spots disappeared instantly, when the chlorite of soda 
came in contact with them — that the antimonial spots were not altered in colour, 
and finally that the spots consisting of a mixture of the two, lost a portion of 
the colour, owing as they suppose, to a solution of the arsenic in the chlorite of 
soda. This was confirmed by taking the chlorite laying on these spots, ad- 
ding muriatic acid, and then passing a stream of sulphuretted hydrogen through 
it. A precipitate of sulphuret of arsenic was obtained, which was entirely solu- 
ble in ammonia. 

MM. Chevallier and Labarraque propose to continue these observations, 
and to ascertain whether it is not possible by means of the chlorite of soda to 

»19 



222 Progress of the Medical Sciences. [July 

separate arsenic from its combinations with other metals. — Bulletin of the Royal 
Academy of Medicine, meeting of the 14th of December, 1841. T. R. B. 

87. Nicotine. — Paris Academy of Sciences, February 7th, 1842. — M. Barral 
read an extract of a memoir on some experiments made by him on tobacco, and 
on the extraction of nicotine, a substance discovered by Vauquelin in 1809. 
M. Barral had succeeded in obtaining this substance in a state of purity and 
had analyzed it. He found it to be a powerful alkali, under the form 
of a liquid, with a very low equivalent, and therefore capable of great satura- 
tion, as compared with other vegetable alkalies. It was also a very energetic 
poison, and taken in feeble doses, was found to produce almost instantaneous 
dQ2ii\\,'-Jlthenxum, February 19, 1842. T. R. B. 

88. Ergot — Some recent notices concerning this substance, deserve a brief 
summary. Mr. Quekett, who has already investigated the cause of its forma- 
tion, and who, from numerous observations, attributed it to the grain becoming 
infested with a parasitic fungus, but left the question in doubt, as to the method 
by which this singular formation probably originates, is now of opinion, from 
several experiments made by him, that " the absorption of the sporules of the 
fungus, by the fibres of the root of the germinating grain, will be found to be 
the true cause of this singular production, and that when they arrive at the 
grain, they convert it into the body known as the Ergot." 

By exposing wheat and barley, as well as rye to the influence of this fungus, 
the latter was affected, and the two former not. It is particularly liable to this 
disease, and that it becomes so, arises either from constitutional properties or its 
anatomical peculiarities. 

M. Bonjean of Chambery has investigated the nature of ergot. He is of 
opinion, that if gathered on the first day of its formation, it is not so poisonous 
as when taken on the sixth — that a heat of 212° Fah. also injures its poisonous 
properties, as does also fermentation. He has discovered two active principles 
in it. One is the oil of ergot, of an acrid flavour, yellowish colour, soluble in 
cold ether and boiling alcohol. It possesses poisonous properties in a high de- 
gree. The author considers that twelve grammes of this oil are equivalent to 
thirty-two grammes of the ergot of rye. A high heat, however, destroys these 
violent properties, and converts it into a resin. It is better therefore to prepare 
it with cold ether. The second is the aqueous extract which is obtained by 
treating the powder, deprived of its oil or not, with water. It is brown, of a 
thick consistence and musty smell. It is soluble in water, and can be formed 
into mixtures, syrups and pills. It is not at all poisonous, but possesses anti- 
hemorrhagic properties, — London Medical Gazette, October 1841, and January, 
1842. T. R. B. 

89. Suicide from Asphyxia hy choking, from the introduction of a firm plug into 
thefauces. — Mary Ann Palmer, a female in good health, aged 29 years, was 
found dead in her sleeping apartment. The cavities of the head, chest and 
abdomen were examined, and the medical certificate was that she had died of 
(simple) apoplexy. The body was received by Dr. Handyside, Lecturer on 
Surgery at Edinburgh, for public dissection, in accordance with the provisions 
of the Anatomy Act. 

Dr. Handyside noticexl the appearance of the brain, but found nothing ade- 
quate to account for death. Twenty-six days after receiving the body, he had 
occasion to demonstrate the muscular structure of the pharynx, and for this pur- 
pose, introduced his finger into the back part of the mouth, in order to stuff that 
cavity with hair. But he found that space already pre-occupied by a dense 
foreign substance, apparently round in form, and impacted between the root of 
the tongue and the soft parts, so very firmly, as to have cut off the supply of air 
to the lungs, by forcibly closing the mouth, and posterior nares. 

He dislodged this body with considerable difficulty, and found it to consist of 
portions of soft cotton, called spindle ends. These were recognized by the par- 



1842.] Medical Jurisprudence and Toxicology, 223 

ties interested, as having been used by the deceased in the solitary employment 
which she pursued at her death. Some of this cotton she had untwisted and 
rolled up very closely, coiling over it two strips of flannel, vv'hich she had bor- 
rowed the last time she was seen in life. Finally, she had fastened these 
materials tightly together, by means of a large rough pin. The ping, when 
removed, presented a conical shape, somewhat curved, of 3^ inches in length, 
1| inch in breadth at its base, and three-fourths of an inch in breadth at its 
apex. 

Among the interesting circumstances attending the case, were the facts, that 
on inspecting the interior of the mouth, the soft palate presented on the left side 
of the uvula (the part corresponding with that portion of the plug where the 
rough head of the pin projected) a small though deep laceration of its texture, 
and which, although twenty-eight days had elapsed since death, was surrounded 
by a circumscribed patch of ecchymosis^ that remained still of a vermilion hue. 
The right side of the soft palate was similarly ecchymosed, but not lacerated. 
The surfaces of the anterior fourth of the tongue, and the hard palate opposite 
to it — parts which had been compressed by the broad and round base of the plug 
— exhibited each a transverse band of ecchymosis, but paler than in the former. 
Lastly, the epiglottis and arytenoid cartilages, which appeared to have been 
violently separated by the last expiration, and were retained apart by the narrow 
and rough extremity of the plug, exhibited diflused ecchymoses, as evidenced 
by the traces of coagulated blood that on dissection were displayed underneath 
the mucous membrane investing the larynx. 

It is necessary to understand, that death in this case occurred on the 27th of 
December, and also (although Dr. Handyside does not appear to attach any im- 
portance to this) that a solution of nitre, an ounce to a pound of water, had 
been introduced along with the ordinary injection materials, into the arteries of 
the body. 

The importance of inspecting all the cavities of the body in medico-legal 
cases, is forcibly urged from a review of this case. " It is to be remembered 
that in every case of death by choking, smothering, or strangulation, the natural 
appearances of the body are not necessarily altered. Accordingly, in the pre- 
sent instance the surface of the great cavities of the body appeared to be perfect- 
ly healthy in their structure and contents." — Edinburgh Med, and Surg. Journ, 
April, 1842. T. R. B. 

90. Minute quantity of Opium destructive to the life of a child. — Mr. Everest 
delivered a woman of a healthy female child, and prescribed a draught composed 
of twelve minims of laudanum in an ounce of pimento water to relieve the after 
pains. Two days after, on calling, the nurse told him that she had given the 
child half a teaspoonful of the draught prepared for the mother, in order to com- 
pose it, and to prevent its crying. The child was labouring under all the symp- 
toms of poisoning. Stimulants and artificial respiration were employed with 
some benefit, but the coma returned, and the child finally died in fourteen hours 
after taking the laudanum. In this case, a child two days old was destroyed by 
a minim and a half oi laudanum. Dr. Christison mentions as the smallest fatal 
dose, that of a child three days old, who took by mistake, about the fourth part 
of a mixture containing ten drops of laudanum. Dr. Kelso relates a case (Lan- 
cet, N. S. vol. 21, p. 304,) where /our drops of laudanum given to a child nine 
months old, were probably the cause of death. — Lancet, February 26, 1842. 

T. R. B. 

91. Signs of Pregnancy. — Kiesteine. — Mr. Letheby states that out of fifty 
cases experimented on by him, at all dates between the second and ninth month 
of utero-gestation, he obtained unquestionable evidence of its presence in forty- 
eight. 

In seventeen non-pregnant women, there was no indication of its presence. 
In examining the urine of ten women during the time of suckling, he found it 



224 Progress of the Medical Sciences. [July 

in all immediately, after delivery, but the evidence of its existence fell off at a 
period between the second and sixth months. 

He directs that the urine be obtained when the female is as free from disease 
as possible, and that passed early in the mornincr should be selected. Expose 
this, in a tall narrow glass, to a temperature of about 70° Fah. A much lower 
temperature, as 40°, will delay its production for weeks. In two or three days, if 
the woman be pregnant, the first indication is turbidness. In a day or two more, 
a thin pellcle forms on the surface, and this gradually acquires consistence up 
to a fortnight. The odour is peculiar, not like cheese, as Dr. Bird states, but 
like that of our beef beginning to putrify. 

The peculiar pellicle needs not to be confounded with others, and common 
ones. The liihates give out the smell of ammonia, and when disturbed fall to 
the bottom. Neither of these occurs with kiesteine. Lond. Med. Gaz., Decem- 
ber, 1841. T. R. B. 

92. New Test for Nitric Jlcid. — The difficulty of finding a distinctive test for 
this substance is acknowledged by most writers on Toxicology, and we are in 
doubt whether the present will materially aid in removing it. The substance 
prepared (by a writer in the Chemist, a recent periodical) is the hydrargyro- 
cyanide of iodide of potassium. It is formed by mixing cyanuret of mercury 
and iodide of potassium together, in their equivalent proportions, and dissolving 
the salt in small quantities of warm water, from which, on cooling, it is depo- 
sited in beautiful plates. 

If one of its scaly crystals be put into most of the acids, as the sulphuric, 
muriate, hydrofluoric, chromic, phosphoric, and the common vegetable acids, it 
immediately becomes of a beautiful red, being changed into biniodide of mer- 
cury, but in concentrated nitric acid, of the specific gravity 1.4 to 1.5, the scale 
almost instantly becomes black, from the liberation of iodine. This effect is 
visible upon a very small portion of the salt. 

It has been found also to blacken with chlorine, bromine, sulphuretted hydrogen, 
nitrous acid, ^c. — It is recommended, in case we suspect the presence of a nitrate, 
to evaporate its solution to dryness, introduce a portion of the residue into a small 
tubulated retort, pour upon it one or two drops of sulphuric acid, apply a gentle 
heat, when a portion of the volatile products will pass over into the receiver 
with which the retort is to be connected, and in which one or two crystals of 
the salt have been placed. If they are blackened, the substance tested is to be 
deemed a nitrate, provided the presence of those substances which might cause 
the same effect have been guarded against. The evolution of peroxide of chlo- 
rine from a chlorate, and the odour of a sulphuret will decide w-ith regard to 
these. — Edinburgh Monthly Journal of Medical Science. T. R. B. 

93. Are medical men liable to punishment if they refuse to make a medico-legal 
dissection, or a chemical analysis, when called upon by the coroner? I have sup- 
posed not, and have so stated. — It might seem at first view to be their duty as 
citizens to further the purposes of justice, but this argument loses all its weight, 
when we recollect that no provision is made in any of our states for their remu- 
neration. Every other officer of justice is paid. 

But suppose the law provides for the payment of services, can a physician 
be then obliged to perform one or the other duty] Can the coroner, (or the offi- 
cer charged with the duty of holding inquests) select a particular individual, 
demand his attendance for the above purpose, and in case he refuses, complain 
of him as guilty of a misdemeanour'? I put these questions, in order to intro- 
duce the narrative of the following case which occurred in Belgium in 1839. 

On the llthof December, Dr. Cambrelin of Namurat4 P.M. was waited upon 
by a subordinate officer of police, with a blank subpoena signed by the chief 
police officer requiring him to examine the body of anew-born infant, which had 
been found dead that morning in a heap of peat, lying in the kitchen of a house 
in the city. Dr. C. observed to the officer that the requisition was in blank, and 
in reply was informed, that it had been presented to a number of physicians 



1842.] Medical Jurisprudence and Toxicology. 225 

since morning, and that all had declined, including the individuals who had for 
the last ten years, been engaged in medico-legal examinations by authority. 
And the officer now proposed that if he would accept, his name should be in- 
serted, and he would thus become entitled to the usual fee. Dr. Cambrelin 
declined assenting to this, and waited upon the Commissary of Police. To him, 
he stated, that he had not particularly attended to medico-legal investigations 
during the last ten years — that the inquiry in question was a difficult one, par- 
ticularly as many new points had been discussed within the period — that as the 
evening was rapidly coming on, some difficulties would be encountered in deter- 
mining the condition of ihe various organs to be examined by candle-light, and 
above all, that the duty properly belonged to the medical officer, who had for 
years, attended to medico-legal dissections. 

The Commissary in reply threatened to complain of him to the tribunal of 
police, unless he immediately undertook the examination. Dr. Cambrelin an- 
swered, make then your complaint. 

When brought before the court, he presented the above points of defence, 
with others, but was found guilty of an infraction of the 475th article of the 
Penal Code, which is of the following import: 

An individual may be fined from six to ten francs, who shall refuse or neglect 
to give the necessary assistance, when required, in cases of accidents, ship- 
wrecks, inundations, as also in cases of robberies, of individuals taken in the 
fact of committing crimes {Jlagrante delicto) hue and cry, and judicial acts, (Exe- 
cution judiciare.) 

It was, doubtless, under the last clause that this decision was justified. Dr. 
Cambrelin in an able argument proves it to be arbitrary and unjust, and declares 
his intention of appealing to the superior court. — Innales D'' Hygiene^ October 
1840. T. R. B. 

94. Poisoning with flour containing had. By Dr. Schillbach {Frorieps 
Nolizen). Six members of a family were suddenly seized with obstinate con- 
stipation, uneasiness, vomiting, colic; to these symptoms, succeeded spasms 
and pains, principally of the liands and feet, remarkable emaciation, paleness and 
anxiety. The eldest son, who suffi?red most, presented dilatation of the pupils, 
paralytic rigidity of the limbs, retraction of the abdomen, a livid complexion 
and excessive emaciation. It was supposed that these symptoms arose from 
poisoning with lead, but without the least trace of that poison, until at last, 
there was found in the cupboard where the family kept their flour, a box full of 
small shot. As this box was cracked, it was supposed that a certain quantity 
of the lead had fallen into the flour, and accordingly an analysis of the small 
portion of the flour that still remained showed traces of this metal. The pa- 
tients gradually recovered after treatment with calomel and opium, and other 
medicines. The author cites as illustrative of the above, a case of severe lead 
colic, brought on by drinking wine from a bottle which had contained some 
grains of lead.— Edinburgh Monthly Journ. of Med. Sci. T. R. B. 

95. On the varieties observed in the symptoms of poisoning with Opium. By 
David Skae, Lecturer on Forensic Medicine. — Period at which. stupor occurs. 
If solid opium has been swallowed, it commonly commences from half an hour to 
an hour. In a case, however, by Desruelles, where two drachms of solid opium 
had been taken, the stupor was complete in fifteen minutes, and on the other 
hand, in the case where the largest quantity was swallowed which has been re- 
corded (American Medical Recorder, vol. 13), viz. eight drachms of crude opium, 
the patient was able, an hour afterwards, to tell her physician connectedly, what 
she had done. Wlien the poison has been taken in solution, or in the form of 
tincture, it acts more rapidly. In several instances, hopeless coma has been 
completely formed in half an hour, and the poison must have begun to act in ten 
or fifieen minutes. An example of this will be presently stated. 

Sleep seems to retard the operation of opium, provided it occurs immediately 
after taking it. There are several instances on record of this description. In 



226 Progress of the Medical Sciences, f*'^"!/ 

one that occurred to Dr. Skae, half an ounce of laudanum was taken, the indi- 
vidual slept thereafter for an hour, and then arose from bed and procured a drink 
for himself, yet in about ten hours afterwards he died with all the symptoms of 
narcotic poisoning. 

Spontaneous vomiting occasionally takes place. Convulsions rarely, but when 
they do occur they are violent, and in only occasional instances, accompanied 
with delirium. Diarrhoea and colic, in some cases, and diuresis in others, now 
and then happen, although ordinarily the opposite effects are produced. 

Death usually follows in from seven to twelve hours. There are instances, 
however, in which life was prolonged for fifteen, seventeen, and twenty-four 
hours, and again individuals have died in five, four, or three hours. 

The following remarkable case varies in several respects from the usual 
course of symptoms. A soldier in the 29th Regiment stationed in Edinburgh 
Castle took two and a half ounces of the liquor opii sedativus, twenty minutes 
before nine P. M. He was seen a quarter of an hour thereafter by Dr. Cooper, 
the surgeon, who found him totally insensible. The face was purple, and the 
features distorted, the pupils dilated and insensible, the breathing stertorous and 
accompanied with hiccough, and the pulse slow and small. The stomach was 
emptied and washed out by means of the stomach pump, and the other remedies 
usual in such cases were adopted, but the man expired at ten P. M., an hour and 
twenty minutes after swallowing the poison. The body was examined carefully, 
and with the exception of tiie liver, which exhibited extensive disease of old 
standing, no morbid appearances of any note were found. The blood-vessels 
within the cranium contained a considerable quantity of blood, and some serous 
fluid was found in the lateral ventricles. The fingers and toes were contracted, 
and still rigidly retained their positions. From this circumstance, and from the 
distortion of the features during life, it may be conjectured that the individual 
died partially convulsed. It is probably the most rapidly fatal case on record. — 
Edin. Monthly Journ. of Med. Sci. T. R. B. 

96. Advanced stage of the Putrefaction of the Brain, ivithout any corresponding 
appearances in the rest of the body. — M. Millet calls the attention of medical 
jurists to the facts of the following case. On the 29ih of August, 1840, an in- 
dividual (a patient of M. Leuret) labouring under dementia and general para- 
lysis expired. The body was, a few hours thereafter, removed to a cool room 
and laid on a zinc table. Here it remained during forty-one hours, when the 
dissection commenced. The temperature was about 86° of Fahrenheit. 

The dura mater was found strongly adhering in several places. After separat- 
ing it, and opening into the brain, the cerebral mass of both hemispheres was 
seen converted into a yellowish-green fluid streaked with blood, of an offensive 
and penetrating odour. In the midst of this putrid mass, near the left corpus 
striatum, there was a portion more solid and resisting, evidently the result of a 
ruptured vessel (wn foyer apoplectique.) It was surrounded by a number of 
whitish vesicles, which on being opened, discharged a brick-red matter. 

When the cerebral mass was spread on the table, it was scarcely possible to 
distinguish any of the circumvolutions— so complete had been the progress of 
putrefaction. Indeed the lower part of the brain was green, and more spotted 
than the upper. The cerebellum was also in a state of complete solution, and 
even the spmal marrow, on being traced, was in a similar condition and of a 
gray colour passing to green. 

On the other hand, the right lung was healthy, but engorged; the left lung 
bore the marks of effusion, with some recently formed membranes; the heart 
was flaccid and discoloured; the stomach and intestines healthy; the liver and 
spleen a little softened and enlarged; the muscles of the trunk and extremities 
firm and hard; and the external appearance as usual in a dead body, except that 
the skin of the superior extremities was slightly greenish. 

Mr. Millet inquires, if the head of this individual had been separated from the 
body (as in a case of assassination), any medical jurist would have recognized 
their connection, or whether he would assign so short a period since death, as 
two day si —^mia/es D' Hygiene January, 1841. T. R. B. 



1842.] Medical Jurisprudence and Toxicology, ' 237 

97. Birth of a living child on the 179/A day. — The following^ case is probably 
as well authenticated both by facts and attendant eircutnstances, as any that 
have been already published. Mrs. R. a well-formed woman, aged 21 years, 
stated that she was married July 22, 1839, that she menstruated naturally the 
week before marriacje, but that the menses had never after returned. About 
three weeks previous to the evenino- on which she experienced the first pains 
of labour, she stumbled and fell, and was instantly seized with a pain in her 
back, that had never entirely left her. She suffered also under frequent nausea 
and rigors. Mr. Tait, who relates the case, was called to her on the 17th of 
January 1840, and the birth ensued in about seven hours after the commence- 
ment of labour. 

The child, a female, was so extremely feeble, that no one supposed it would 
survive. Its cry was so weak, as to be heard only for a few yards; there were 
no nails on its fingers or toes; a thick down covered the head instead of hair; 
the skin everywhere was unusually florid and thin; and the extremities imper- 
fectly developed; the bones of the head were soft and easily compressed, and their 
approximation at the sutures was imperfect. The membranas pupillares were 
entire. The child was wrapped in soft cotton, and kept in a basket near the 
fire. It was so feeble, as to be unable to grasp the mother's nipple, and for the 
first three weeks, was nursed by milk taken from the breast, introduced at first 
by a quill, and afterwards by a teaspoon. 

As soon as it began to suck, its whole appearance improved, and hopes were 
now entertained of rearing it. It was first accurately weighed and measured on 
the 27th of February, forty days after birth, and the result was— weight, three 
pounds; length, thirteen inches; centre of the body, nearly an inch above the 
umbilicus. 

March \&th. — The child was weighed a second time in the presence of Pro- 
fessor Simpson of Edinburgh. Its length was now 13J inches; weight, three 
pounds, ten ounces and a half; centre of the body three-quarters of an inch 
above the umbilicus. As it w.as labouring under purulent ophthalmia, it was 
impossible to ascertain whether the membranae pupillares had undergone any 
change. The appearance was, however, improved, and it cried with a stronger 
voice, though still feebler than children usually do. 

Jlpril Wlh. — Weighed again. Weight, five pounds three ounces; length, 
seventeen inches; centre of the body at the superior margin of the umbilicus. 
The nails are now formed on the fingers and toes, and the down or hair has 
almost entirely disappeared from every part of the body. 

From this period it continued to thrive, until the 27th of May, when it was 
seized with measles, and died after two days' slight illness. — Lancet, April 23, 
1842. T. R. B. 

98. Child horn at the end of the fifth month, which lived six days — Dr. John 
Cochrane, of Edinburgh, relates an interesting case of this in the Lon. and Ed. 
Monthly Journ. Med. Set. (March, 1842), which we have to regret, however, is 
imperfect in its details. 

Mrs. B. about the end of her fifth month of pregnancy, was delivered by Dr. 
C. of a male child, on the morning of the 19th of October, 1841. The child 
did well until the night of the 25th, when he died. " He thus completed nearly 
six days, during which he passed the urine and feeces in a natural way, and 
seemed likely to thrive as well as a child come to the full time. 

The testes had not descended. The weight was only two pounds and eight 
ounces; the length of the body was only 14 inches; the circumference of the 
chest was nine inches; the length from the vertex to the point of the nose six 
inches; and the occipito-frontal circumference eight inches. Considering the 
very small weight of the body, it is certainly remarkable that the child lived so 
long as he did. 

A post-mortem examination was not allowed. 



228 Progress of the Medical Sciences, [^"^7 

99. Recovery from taking two drachms of Arsenic. — Mr. Toogood relates the 
following example of this. W. R. aged 17, swallowed two drachms of arsenic, 
which he coarsely bruised with the end of a bottle at nine, P. M., on the 2d of 
June, 1817, with a view to self-destruction. He repented, and made it known 
a quarter of an hour afterwards. Six grains of emetic tartar were immediately 
given and quickly repeated. Vomiting was soon excited, and briskly kept up, 
by copious draughts of warm water for two hours. Nothing was retained on 
the stomach during the night, and he complained of constant and severe pain in 
the stomach and bowels. He passed the night without rest, and on the follow- 
ing morning he complained still of great pain in his stomach and bowels, was 
very hot, with a frequent pulse and flushed countenance. He was copiously 
bled, and his bowels were relieved by injections, but nothing could be retained 
on the stomach until the evening after the application of a blister. Effervescing 
medicines, with opium, were then kept with difficulty, but he was not so much 
relieved until the fourth to make his recovery certain. — Prov* Med. and Surg. 
Journ. January 1, 1842. 



MISCELLANEOUS. 

100. .Animal Magnetism. — After an interesting and judicious paper read to the 
Westminster Medical Society, by Mr. Longmore, condemnatory of animal mag- 
netism, the discussion was much enlivened by the practical exhibition of the mes- 
meric treatment upon a susceptible subject, one of the members of the society, who 
was well known, and beyond suspicion. The subject of the experiment was a 
young gentleman of about nineteen years of age, of the sanguine-nervous tem- 
perament, robust, and healthy. Having taken a seat at the table, the chairman 
entered into conversation with him, obviously for the purpose of removing any 
agitation that might exist, that the experiment might be fairly conducted. The 
society was informed that one of the peculiar features of this case was the 
power the individual possessed of inducing upon himself the ^^crisis,''^ or the 
"mesmeric sleep," without manipulation, or the intervention of a second party. 
Having taken his seat in the area, he showed the society how he could induce 
the "crisis." He held a pen towards the point of his nose, and fixed his eyes 
(which necessarily squinted a little) upon the pen, but his fins^er he said would 
do equally well. Having continued steadfastly gazing, as it were, at the point 
of his nose for about forty or fifty seconds, he fell back upon the chair in a fit 
similar to that of epilepsy, with this difference, that the muscles of his face 
were not distorted, nor was there any foaming at the mouth. The muscles of 
the trunk and limbs were, however, rigid; his pulse quick and irregular; the 
pupils dilated, and the tips of his fingers ice-cold. When an arm or leg was 
raised, it remained out-stretched and rigid in the position in which it was placed, 
as in cataleps)^ While sitting on the chair with his head much drawn back- 
wards over the back of the chair, first, one arm was raised by an assistant 
evidently with some difficulty from the rigidity of the muscles, till the limb was 
at right angles with the trunk, when it remained fixed in that position. The 
other arm was then raised in a similar manner, and left fixed at a similar angle. 
It was proposed then to try the effects of lifting the legs. While the young 
man was still sitting with his arms projecting forwards at right angles, one foot 
was first raised till the whole lower limb projected forwards upon a level with 
the seat of the chair; the other foot was then treated in a similar manner, and 
the four limbs left in these awkward positions for a much longer period than 
could be maintained by any voluntary effort. He was aroused after some mi- 
nutes by a smart stroke upon one of the outstretched limbs, and appeared much 
confused and bewildered, but soon regained his usual appearance. Soon after- 
wards the chairman tried upon him the usual manipulations, but with the backs 
of the hands instead oi ihe palms; a process which is said to be entirely useless, 
or inadequate to produce, according to the adepts, any mesmeric effects what- 



1842.] 



Miscellaneous, 229 



ever. While these passes were being made, the chairman inquired how the 
young man felt; and he replied, that he had a sensation as if electricity was 
passing- through him. The chairman then pointing with his forefinger to the 
forehead of the young man, requested him to look steadfastly at his (the chair- 
man's) finger, which he did, and in less than a minute he dropped in a "cmzs.'" 
The rigidity of the muscles was as great as in the former experiment, and no 
doubt could be entertained that the young man was totally insensible to ail that 
was passing around him. This was proved to the satisfaction of the society by 
various experiments upon the skin and upon the eye. After numerous trials of 
the state of his sensibility, the young man was lifted and placed erect upon his 
feet, and held in that position for some time, every muscle being apparently in 
a rigid state of contraction. After remaining for some minutes in this cataleptic 
state, he was roused as before by a smart blow upon the arm; and though stand- 
ing still upon his feet, he appeared when thus struck to be aroused from a deep 
sleep, and seemed at first amazed at what was going on around him. 

The chairman having been requested by the society for an explanation of the 
phenomena just witnessed, said, although he doubted whether a satisfactory 
answer could be given, it was to him perfectly obvious that the phenomena were 
not attributable to any new agency developed and introduced into the system 
of the young man, for the fit could obviously be induced by the young man 
himself more quickly than by the agency of another. Whatever might be the 
cause of the lit, it could not possibly be attributable to animal magnetism, or to 
any extrinsic cause. According to the chairman it depended upon a peculiar 
state or idiosyncrasy of the nervous system — the epileptic, — which might be 
called into activity by various causes, as mental emotion, imagination, a habit 
of recurrence by the induction of some oi \\\e precursory movements of epilepsy, 
or even by inducing a peculiar state of a single nerve. The chairman was in- 
clined to attribute the phenomena in the case before the society to the last of 
these causes. A peculiar impression was first induced on the optic nerves of the 
young man, by the fixing steadily, and for some time, the eyes upon a given 
point: a state similar to that induced by pressure upon the nerves of a limb 
when a numbness or " sleeping" of the limb occurs. The state of the optic 
nerve thus induced, he conceived, was transmitted, by continuous sympathy, to 
the brain and whole nervous system, with its necessary effects upon conscious- 
ness and the motive and sensitive powers. 

The subject excited considerable discussion, and the majority of the speakers 
concurred with the essayist in the views he supported in opposition to animal 
magnetism. — Lancet^ 1842. 

101. Abstract of a paper on Opium smoking in China, By G. H. Smith, Esq., 
Surgeon in Penang. Communicated to Dr. Johnson by the author. — The great 
extent to which this destructive vice is carried on in this island, and in the straits 
and islands adjacent, together with the almost utter impossibility of relinquish- 
ing the dreadful habit, when once acquired, opens an immense source of revenue 
to the East India Company, who monopolize the sale of all quantities of opium 
under a chest, as well as that of arrack, seree, toddy, bang, &c. The annual 
average revenue of this monopol}'-, or " Revenue-Farms," as they are called, for 
ten years past, has amounted to 4822/. sterling. But the quantity of opium 
smuggled is immense and incalculable. Benares opium is that chiefly used by 
the farmer for the preparation of "chandoo" (the composition smoked), on ac- 
count of its weight and cheapness; but the consumers prefer the Patna opium, 
because it has a finer flavour, is stronger, and its effects more lasting. 

The following is part of the mode of preparing the chandoo. Two balls are 
as much as one man can properly prepare at once. The soft inside part of the 
opium-ball is scooped out, and the rind is boiled in soft water, and strained, 
through a piece of calico. The liquor is evaporated in a wide vessel, and all 
impurities carefully skimmed off, as they rise to the surface. The same process 
is gone through with the soft opium extracted from the ball; and all being mixed 
and evaporated to the consistence of dough, it is spread out into thin plates, and 
No. VII.— -July, 1842. 20 



230 Progress of the Medical Sciences, [July 

when cold, it is cut into a number of long narrow slips. These are again reduced 
to powder, redissolved, again evaporated, and ultimately rolled up into balls, 
and a good deal resemble shoemaker's wax. In this state it is fit for smoking, 
and is at least twice the strength of crude opium. The Chandoo, when once 
smoked, does not entirely lose its powers, but is collected from the head of the 
pipe, and is then called " Tye-chandoo," or fsecal opium, which is made into' 
pills, and swallowed by those whose poverty prevents them from smoking the 
Chandoo itself. 

In Penang, the opium-smokers are the Chinese, the Malays, and a very few 
of other nations, chiefly the native Portuguese. It is calculated that 10 per cent, 
of the Chinese, 2| of the Malays, and about 1 per cent, of other natives, are ad- 
dicted to the vice of opium-smoking. The poorer classes smoke in the shops 
erected for that purpose, but the wealthier orders smoke privately in their own 
houses. The practice is almost entirely confined to the male sex, a few aban- 
doned prostitutes of the other sex partaking of the vice. A young beginner will 
not be able to smoke more than five or six grains of chandoo, while the old 
practitioners will consume 290 grains daily! I 

The causes which lead to this dreadful habit among the Chinese are, — First, 
their remarkably social and luxurious disposition. In China, every person in 
easy circumstances, has a saloon in his house, elegantly fitted up, to receive his 
friends, with pipes, chandoo, &c. Ail are invited to smoke, and many are thus 
induced to commence the practice from curiosity or politeness, though few of 
them are ever able to discontinue the vice afterwards. 

Parents are in the habit of granting this indulgence to their children, appa- 
rently to prevent them from running into other vices still more detestable, and to 
which the Chinese are more prone than, perhaps, any people on earth. There 
is another cause which leads great numbers of young men into the practice of 
opium-smoking, a belief, founded, it is said, on experience, that the said prac- 
tice heightens and prolongs venereal pleasures. It is, however, admitted by 
all, that opium-smokers become impotent at a much earlier period of life than 
others. In painful or incurable diseases, in all kinds of mental or corporeal suf- 
ferings, in mercantile misfortunes, and in other reverses of fortune, the opium- 
shop is resorted to as an asylum, where, for a time at least, the unfortunate may 
drown the recollection of his cares and troubles in an indescribably pleasurable 
feeling of indifference to all around. The Malays are confident that opium- 
smoking inspires them with preternatural courage and bodily strength; it is, 
therefore, resorted to whenever any desperate act is in contemplation. 

The smoking-shops are the most miserable and wretched places imaginable: 
they are kept open from six in the morning till ten o'clock at night, each being 
furnished with from four to eight bedsteads, constructed of bamboo-spars, and 
covered with dirty mats and rattans. At the head of each there is placed a 
narrow wooden stool, which serves as a pillow or bolster; and in the centre of 
each shop there is a small lamp, which, while serving to light the pipes, diffuses 
a cheerless light through the gloomy abode of vice and misery. On an old table 
are placed a few cups and a tea-kettle, together with a jug of water, for the use 
of the smokers. At one side of the door the sub-farmer, or cabaret-keeper, sits, 
with chandoo, pipes, &c., for the accommodation of his customers. The place 
is filled with the smoke of the chandoo, and with a variety of other vapours, 
most intolerable to the olfactories of an European. The pipe, as may be seen, 
is composed of a shank and a head-piece, the former made of hard and heavy 
w^ood, fourteen inches long by three inches and a half in circumference. It is 
bored through the centre, from the mouth-piece to the head, where there is a 
kind of cup to collect the " tye-chandoo." 

The smokers generally go in pairs, and recline on the bedstead, with head rest- 
ing on the wooden stool. The mode of proceeding is as follows: — First, one of 
the pair takes up a piece of chandoo on the point of a short iron needle, and 
lighting it at the lamp, applies it to the small aperture (resembling the touch-hole 
of a gun), in the head of the pipe. After a few whiffs he hands the pipe to his 
friend, who lights another piece of chandoo at the lamp; and thus they go on 



1842.] Miscellaneous. 231 

alternately smoking- till they have had sufficient, or until they are unable to pur- 
chase any more of the intoxicating dru^. The fume is always expelled through 
the nose, and old stagers even draw it into their lungs before it is expired. 

During this time, they are at first loquacious, and the conversation highly ani- 
mated; but, as the opium takes effect, the conversation droops, and they fre- 
quently burst out into loud laughter, from the most trifling causes, or without 
any apparent cause at all, unless it be from the train of thoughts passing through, 
their excited imaginations. The next phase presents a vacancy of countenance, 
with pallor, and shrinking of the features, so that they resemble people conva- 
lescing from a fever. A dead silence precedes a deep sleep, which continues 
from half an hour to three or four hours. In this state the pulse becomes much 
slower, softer, and smaller than before the debauch. Such is the general pro- 
cess almost invariably observed among the Chinese; but with the Malays it is 
often very different. Instead of the placidity that ushers in the profound sleep, 
the Malays frequently become outrageously violent and quarrelsome, and lives 
are occasionally lost in these frightful orgies! 

The chandoo is sometimes employed for the purpose of self-destruction; but 
from its strong smell and taste, it is never used as poison for others. It does 
not appear that sudden death is ever produced by an overdose of chandoo when 
used in smoking. When an inordinate quantity has been expended in this way, 
headache, vertigo, and nausea are the effects, and are only relieved by vomiting. 

When a person has once contracted the habit of opium-smoking, he finds it 
extremely difficult to discontinue the vice; yet there are many instances of its 
being conquered by resolution of mind. In such attempts it is most dangerous 
to approach the opium-shops, as the smell of the chandoo produces an irresistible 
desire to indulge once more in the pernicious habit; neither can opium-smoking 
be suddenly abandoned without some substitute, as the most serious or even 
fatal consequences would ensue. The best substitute is a tincture of the " tye- 
chandoo" (which is about one-fourth the strength of the " chandoo" itself), 
made with samsoo, a spirit made from rice, and taken in gradually diminished 
doses, till the habit is broken. 

By a continuance in this destructive practice, the physical constitution and the 
moral character of the individual are deteriorated or destroyed, especially among 
the lower classes, who are impelled to the commission of crimes, in order to 
obtain the means of indulging in their dominant vice. 

The hospitals and poor-houses are chiefly filled with opium-smokers. In one 
that I had charge of the inmates averaged sixt)'^ daily, five-sixths of whom were 
smokers of chandoo. The baneful effects of this habit on the human constitu- 
tion are conspicuously displayed by stupor, forgetful ness, general deterioration 
of all the mental faculties, emaciation, debility, sallow complexion, lividity of 
lips and eyelids, languor and lack-lustre of eye, appetite either destroyed or de- 
praved, sweetmeats or sugar-cane being the articles that are most relished. In 
the morning these creatures have a most wretched appearance, evincing no symp- 
toms of being refreshed or invigorated by sleep, however profound. There is a 
remarkable dryness or burning in the throat, which urges them to repeat the 
opium-smoking. If the dose be not taken at the usual time, there is great pros- 
tration, vertigo, torpor, discharge of water from the eyes, and in some an invo- 
luntary discharge of semen, even w^hen wide awake. If the privation be 
complete, a still more formidable train of phenomena take place. Coldness is 
felt over the whole body, with aching pains in all parts. Diarrhoea occurs — the 
most horrid feelings of wretchedness come on; and if the poison be withheld, 
death terminates the victim's existence. 

It is generally remarked, as might, a priori be expected, that the offspring of 
opium-smokers are weak, stunted, and decrepit. It does not appear, however, 
that the Chinese, in easy circumstances, and who have the comforts of life about 
them, are materially affected, in respect to longevity, by the private addiction to 
this vice, so destructive to those who live in poverty and distress. There are 
many persons within the sphere of my own observation, who have attained the 
age of sixty, seventy, and more, and who are well known as habitual opium- 



232 Progress of the Medical Sciences. [July 

smokers for more than thirty years past. It is a well-known fact, that the pre- 
sent Emperor of Cliina was a slave to the pernicious habit of smoking opium for 
many years; but that, by great moral courage and perseverance, he weaned 
himself from the vice, and has ever since become a most violent persecutor of 
those who are addicted to the indulgence. He accordingly issued edicts of 
severe punishment against the smoker, vendor, importer, and all concerned in 
the traffic of opium; and, finding these ineffectual, he made the crime capital, 
and punished it with death. Whatever may be said in favour of the opium 
traders, and against the policy or justice of the Chinese emperor, I am convinced 
in my own mind that the real object of his edicts was the good of his subjects, 
and that he hoped, however vainly, to eradicate a vice destructive alike of the 
health and morality of those who become its victims. But his majesty's govern- 
ment acted on very different principles; namely, the most selfish, venal, and 
mercenary. It is a notorious fact, that many, perhaps most of the officers, em- 
ployed in preventing the importation and smuggling of opium, are themselves 
opium-eaters, or opium-smokers, and consequently that they wink at the illicit 
trade, or take bribes of opium or dollars for the introduction of the drug. It is 
well known now, that in several of the southern provinces of China, opium is 
cultivated to a great extent, without any check from the local authorities, and, 
doubtless, without any knowledge of the emperor himself. The propensity to 
opium-smoking is becoming so universal and so irresistible in China, that no 
sumptuary laws, however sanguinary, will be able to stem the torrent. In 
Penang excessive duties have only increased the thirst for opium, and vi-'hat is 
worse, they have quadrupled the number of murders and other crimes committed 
in order to obtain the means of procuring the drug! ! 

Pulo Penang, Straits of Malacca. 

Note hy Dr. Johnson. — The foregoing paper has been laid before the society, 
partly because the subject is curious, and little known in this country, but chiefly 
for the purpose of offering one or two practical snggestions to the members. 

First, 1 think it will be admitted that the Chinese mode of taking opium 
by smoking or inhalation, induces the peculiar sedative effects of that drug more 
powerfully and more speedily than when taken into the stomach. 

Second, There can I believe, be little doubt, that these effects are produced 
chiefly, if not entirely through the medium of the nervous system, and not by 
digestion, absorption, and the circulation. 

Third, It does not appear that the casual or temporary smoking of opium is 
more dangerous or injurious to the constitution than that of swallowing the drug, 
whether in substance or solution. On the contrary, I believe it is less so, and not 
so likely to impair the functions of the stomach, liver, and bowels, as when di- 
rectly applied to the digestive apparatus. 

Fourth, The habitual abuse of a drug, by which, in fact, it is converted into a 
poison, is no argument or reason against its occasional exhibition as a remedial 
agent. 

Fifth. If the above observations be admitted as rational, I see no reason why 
we should not employ the Chinese mode of inhaling the fumes of opium, in 
certain dangerous and painful maladies where the common mode is found to be 
inefficient, and attended with great derangement of the digestive organs. It is 
clear that we can very seldom induce that profound sleep and insensibility to all 
mental misery and corporeal pain, by opium taken into the stomach, which we 
find to be produced by the inhalation of its fumes acting directly on the brain, 
through the medium of the nerves. Might not the Chinese mode, then, be 
adopted in tetanus, hydrophobia, tic-douloureux (especially of the facial nerves), 
violent spasms, and painful diseases that defy the power of opium taken in the 
common way?* 

* This idea has been acted on in France for several years. The cigars, which are 
made for this purpose, have also been imported into this country, and we have used 
them in several cases of tic douloureux, and sometimes have found them to afford great 
relief to the patient. — Ed. 



1842.] Miscellaneous. 233 

The various preparations of opium might be easily smoked by means of a 
common pipe, and the powerful effects induced in a very short space of time, 
without the possibility of their being rejected by the stomach, or prevented 
from acting energetically on the sensorium, and throughout the whole nervous 
system. — Med. Chirurg. Rev. April, 1842. 

102. The Bavarian Schools of Medicine suspended. — The Home Secretary of 
State in Bavaria has recently forwarded an ordinance to the three universities 
of that kingdom, enjoining them to close all the schools of medicine. The mo- 
tives of this injunction are stated to be the fact that more medical men exist 
than can find occupation, and there are 700 applications to the minister from, 
young medical men who seek employment. 

103. Desertion of children in France. — MM. Terme and Monfalcon state that 
in large manufacturing districts, and among artisans, the parents separate 
themselves from their children, with a most lamentable carelessness, and look 
on it as infinitely more convenient and desirable to take their children to a 
hospice, and to forget them, than to trouble themselves about bringing them up. 
M. Lelong, a member of the general council of the Seine Inferieure, states that 
in some neighbourhoods the number of foundlings has equalled, and sometimes 
even exceeded, the number of children born out of wedlock. At the Hotel- 
Dieu, at Lyons, there is a lying-in ward for the wives of the artisans, in which 
from 500 to 600 are delivered annually. More than 60 of these women are de- 
tected every year by the vigilance of the police, in their attempt to send their 
children to the hospice, and are compelled to take them back again. Many 
elude the officers, and succeed in getting rid of their children. 2,000 are ad- 
mitted every year into the foundling hospital at Lyons, and of these 400 are 
considered to be legitimate. During the twenty years from 1816 to 1835, 57,400 
women have been delivered in the Maternite, at Paris, and 19-20ths of them 
sent their children to the Hospice des Enfans trouves. — B. and F. Med. Rev, 
April, 1842. 

104. University College, London. — Dr. Murphy, late assistant physician to the 
lying-in hospital, Dublin, has been elected to the professorship of Midwifery in 
this Institution, in the place of Dr. Davis recently deceased. 

105. Obituary Record. — We greatly regret to have to record the death of Sir 
Charles Bell, which took place suddenly on the morning of the 29lh ult., at 
Hallow Park, near Worcester, the residence of Mrs. Holland, whom the de- 
ceased and Lady Bell were visiting on their way to Malvern. 

Sir Charles had been subject to pains about the chest of a spasmodic nature, 
and latterly assuming the characters of angina pectoris. He had been very 
unwell at Manchester a short time before, and had suffered much from pains in 
the stomach during his visits at Hallow; but appeared quite as well as usual on 
the 28th, and had been out for a considerable time during the day. At night the 
pains again became severe, but no danger was apprehended until 8 o'clock on 
the morning of the 29th, when he became rather suddenly very quiet, and Lady 
Bell, greatly alarmed, sent for Dr. Carden, of Worcester, who, on his arrival, 
found him quite dead, with the appearance of life having been for some time 
extinct. 

Sir Charles was 67 years of age, and, with the exception of the complaint 
which proved fatal, retained considerable vigour and activity. He was out 
sketching on the 28th, being particularly pleased with the village church, and 
some fine trees which are beside it; observing, that he should like to repose 
there when he was gone. On Monday last, being just four days after this senti- 
ment had been expressed, his mortal remains were accordingly deposited beside 
the rustic graves which had attracted his notice, and so recently occupied his 
pencil.— Lonrf. Med. Gaz. May 1842. 

We notice with regret the death of the venerable Dr. Yelloly, which took 

20* 



234 Progress of the Medical Sciences, [My 

place on Tuesday, the 1st of February. Dr. Yelloly commenced public life as 
physician to the London Hospital, and lecturer on the practice of physic. He 
was one of the founders of the Medico-Chirurgical Society, one of its most 
zealous supporters, and contributed many papers to its transactions. About 
twenty years ago Dr. Yelloly removed from London to Norwich, and was sub- 
sequently appointed physician to the Norfolk and Norwich Hospital; here he 
devoted much of his attention, in conjunction with his colleague, Mr. Crosse, to 
the subject of urinary calculi. In one of the volumes of the " Philosophical 
Transactions" he published a valuable analysis of the unrivalled Norwich col- 
lection. Few men possessed a finer philosophical taste than Dr. Yelloly, and 
no one ever continued the pursuit of medical science, for its own sake, more 
uniformly during a long life. Dr. Yelloly enjoyed the friendship of Dr. Marcet, 
Dr. Roget, and many other eminent men in the profession, and had gained the 
respect of an extensive circle of acquaintances. He was a man, excellent in 
public and private life. — Prov. Med. and Surg. Journ. Feb. 1842. 

Died at Berlin in Jan. 1842, Dr. E. Osann, President of the Medico-Chirur- 
gical Society of Berlin and editor of the Journal of Practical Medicine. 

at Paris March 13, 1842, M. Divergie, author of a valuable work on the 

Venereal disease. 

at Hamburgh J. C. G. Fricke, M. D., Surgeon to the Hamburgh Hospi- 
tal, and one of the editors of the Zeitschrift fiir die gesammte Medicin, &c. 

May 9th, at Hyeres near Toulon, Dr. Andrew Blake, a native of Dublin, 

well known in this country as the author of a work on delirium tremens. 



1842.] 335 



AMERICAN INTELLIGENCE. 



Expulsion of a mass of hair from the Uterus. By Henry R. Frost, 
M.D., Charleston, South Carolina. — To give full interest to the above ex» 
traordinary occurrence, it is necessary to detail the circumstances connect- 
ed with a case of tedious and instrumental labour. 

A coloured girl aged 25 years, pregnant with her first child, was taken 
with the pains of labour, about 6 o'clock on the evening of the 9lh of Sep- 
tember, 1838. The habit of the patient was strong, and her health good. 
There was no occurrence during the first twenty-four hours to excite un- 
easiness, but the delay which occasioned the accoucheuse to suppose that 
there was something wrong. 

On the evening of the 10th, I was called to see her. Upon examina- 
tion, I discovered nothing at fault, but the slowness of dilatation in the os 
uteri. There appeared to be some thickening of its orifice. The liquor 
amnii was passing off slowly, the hairy scalp could be felt protruding, and 
the vertex resting upon the brim of the pelvis. To favour relaxation, a 
dose of castor oil had been administered in the morning, and a small quan- 
tity of blood taken from the arm. Expecting that the pains would be 
renewed, and finding nothing requiring my assistance, left the patient in 
the charge of the midwife. 

Sept. nth. — This morning at 9 o'clock, find upon examination, that 
the vertex had made little progress; the os uteri being a little dilated, and 
thinner; repeated the venesection. 

1 o'clock. — But little progress made, and as the pains were exhausting 
without producing much effect, recommended that they be allayed as much 
as possible; directed acetate of morphia in doses of J- of a grain every half 
hour until easier. 

7 o'clock. — The medicine had been taken, and some relief experienced. 

I2th. — The pains were removed during the night, but with litile bene- 
fit. Upon examination, but little change was perceptible; the head had 
descended a little lower, and the protruding scalp filled up the os uteri. 
Apprehending that there might be some obstruction to the passage of the 
head, and that difficulty would occur in the course of the labour, request- 
ed assistance. 

The late Professor Wagner was called, and upon examination, the 
patient concurred in the opinion I had formed of the presentation; recom- 
mended patience and perseverance. The powers of the patient were 
good, and as the pulse was more active than proper, further venesection 
was recommended. 

The condition of the patient was little altered during the day and night. 

I3th. — Still trusting to nature, and nothing done to expedite delivery. 
At 8 o'clock, P. M. the forceps were applied, but with no advantage. In 
the course of the night, the ergot in infusion was freely administered, but 
without any effect. 



236 American Intelligence, [July 

During the day a discharge of meconium in considerable quantity was 
noticed, an occurrence in a presentation of the vertex very unusual. 

In the progress of the labour, it became necessary to draw off the urine 
twice a day, but it is somewhat singular, that though tiie catheter was in- 
troduced, a very small quantity of urine was removed, while a tumour 
which was formed by the distended bladder could not be reduced, though 
pressure was made upon it. 

lUh. — At 9 o'clock A. M. the head was perforated, and the child ex- 
tracted. The operation was completed in about half an hour, and was 
well supported by the patient. The placenta was extracted, and the 
patient made as comfortable as possible; some soreness and tumefaction 
was experienced, and at night nearly two quarts of urine were removed. 

Ibth^ I6th, 11 th. — The patient continues to improve. 

Now 17 th. — The progress of the patient was a very slow, but gra- 
dual amendment. About this period; she complained of fever, which 
continued at variable periods during the day, followed by very profuse per- 
spiration. There was considerable discharge from the vagina of a puri- 
form and very offensive fluid, pains about the region of the pubes at 
times considerable, occasionally tumefaction of the abdomen, the appetite 
variable. To relieve some of these symptoms, general treatment was 
adopted, and the use of an astringent injection. 

19th. — The patient informed me that the vagina was filled with a sub- 
stance, which prevented the introduction of the syringe, that sitting was 
very uncomfortable, and the feeling of something which was to be re- 
moved. 

Upon examination, I discovered a substance of a dark colour, present- 
ing at the OS externum. I provided myself with a pair of forceps, and 
with little trouble extracted a mass, several inches in length, (say 5 inches) 
and an inch and a half in diameter, at its largest part, looking like wet 
tow, of an irregular and somewhat pear-like shape. Carefully inspecting it, 
it proved to be a mass of hair, in short pieces, of an inch to two inches in 
length, very offensive, and saturated with a purulent looking fluid. The 
symptoms above noticed, soon subsided, and the person recovered in a con- 
siderable degree. The preparation is now to be seen in the museum of 
the Medical College of the state of South Carolina. 

The preceding occurrence affords a subject for speculation and inquiry. 

It could not have been an offcast from the first child, the quantity of hair 
being too considerable, and of a different texture from what is usually found 
on a coloured child. 

It must have existed in the uterus at the time the first child was born, 
and must have remained in the cavity of this organ, and the vagina, nearly 
two months after the delivery. This is more remarkable, inasmuch as 
the placenta was removed after the birth of the child, and the condition of 
the uterus carefully examined. 

When removed, it had no appearance of being enveloped with mem- 
branes. 

Was it an abortive effort of nature in the production of twins? or was 
it of that class of morbid growths, which are so frequenfly formed in the 
ovaria? 

Case of expulsion of the Foetus about the sixth month ivith the mem- 
branes entire. By Robert S. Bailey, M.D., Charleston, South Carolina. 



1842.] . American Intelligence. 237 

—Mrs. D. arrived from the country about the 1 5th of June, 1821, affected 
with fever which afterwards assumed an intermittent character. She in- 
formed me, that she supposed herself to be between the fifth and sixth 
months of utero-gestation. I was apprehensive from the first, that abor- 
tion would take place, but endeavoured to prevent, as far as possible, such 
an occurrence by the ordinary means employed in such cases, as bleeding, 
anodynes, <fec. 

July Itli.' — On visiting her, I was informed that she experienced 
some uneasiness last night, and took an anodyne draught which had 
been left for the ague; rested during the night; arose and the pains re- 
turned with violence this morning. I administered tinct. opii, gtt. xxv, but 
without any effect in relieving the pain. The progress of the labour 
now become quick, the pain constant, a slight discharge of water, and the 
ovum was expelled immediately afterwards entire. Such an uncommon 
appearance surprised me; I did not measure it, which I afterwards regret- 
ted, but suppose it was about 18 inches in length, and 9 in breadth. The 
membranes being semi-pellucid, I observed the child to open its eyes. I 
therefore made an opening with a pair of scissors, and placed the child 
attached to the placenta, in warm water; it was curious to observe the ef- 
fect, the vital powers of the child appearing to increase as the stimulus of 
heat was applied, and vice versa, giving a full demonstration of the beau- 
tiful theory of the celebrated Dr. Brown, that " life is a forced state." After 
continuing the immersion about two hours, the child respired perfectly, and 
cried with some strength; it was then separated, and lived about twelve 
hours, and might probably with care, have continued to live. The matrons 
of the family, however, (an authority we can seldom dispute,) concluding 
it to be impossible, and the mother having a numerous offspring, indiffer- 
ence was manifested, as to the use of means. The lady recovered in a 
short time without any unfavourable symptoms taking place. Cases of this 
description may not be uncommon, yet I do not remember to have seen 
any described by obstetric authors under such circumstances, and for that 
reason, now lay it before the profession. 

[Expulsion of the foetus, at a late period of utero-gestation with the 
membranes unbroken, is of rare occurrence, but examples of it have been 
before recorded. Dr. D. Humphreys Storer, of Boston, in the first num- 
ber of our cotemporary, the Neiv England Quarterly Journal of Med. 
and Surg., states that ** in August 1833, a lady was delivered at her full 
time of her first child, a boy, enveloped in the membranes entire — much 
to the amazement of the nurse and her friends." He further states that in 
April of the following year he met with another case, where the woman 
had advanced but seven and a half months in her pregnancy. He could 
not, in this case, break the membranes, but was obliged to cut them, to re- 
lease the child, which was alive and active.— Editor. 1^ 

Statistics of the Medical Colleges in the United States, continued 
from Vol. I, New Series, p. 266.~In 1840, a new Medical School was 
organized at St. Louis (Missouri), being a Department of Kemper College, 
In 1841 the Medical Department of the University of the City of Nev^ 
York was organized. 



238 



Ainerican Intelligence, 



[July 



Colleges. 



1840-41. 

No. attend- Of whom No. deduct- 
ing Lee- were Phy- ing Phy- 
tures 6icians eicians 



1. Bowdoin 62 

2. Dartmouth (1841) 80 

3. Castleton 54 

4. Harvard 88 

5. Berkshire, autumn, 74 

6. Yale 52 

7. New York Col. of 
Phy. and Surg-. 

8. Univ. City N. Y 

9. Albany 

10. Geneva 

11. Univ. of Penn. 

12. Jefferson Med. Col. 163 

13. Med. Col. State of 
South Carolina 

14. Transylvania Univ. 254 

15. Louisville Med. 

Institute 205 

16. Willoughby Coll. 

17. Med. Col. of La. 27 

18. Kemper College, 

St. Louis 40 

19. Med. Coll. of Ohio 

20. Richmond Med. Col. 55 



101 

123 

136 
410 



10 
12 
53 
23 



21 
26 



100 

113 
124 

357 
140 



233 
179 



1841-42. 

No. attend- Of whom No.de- 
ing Lee- were Phy- ducting 
tures sicians Physicians 



118 






103 






47 






109 




109 


239 




239 


101 


5 


96 


211 


58 


1.53 


363 


43 


320 


209 . 


42 


167 


158 






271 


28 


243 


262 


26 


236 


57 


3 


54 



152 



1924 



146 



2400 205 



GRADUATES. 

Colleges. 1840-41. 

Dartmouth 13 

Castleton (1841) 12 

Harvard 16 

Berkshire 20 
Yale 

New York Coll. Phys. and Surg. 25 

University, City New York 

Albany 30 

Geneva 36 

University of Pennsylvania 166 

Jefferson Med. College 57 

Pennsylvania Med. College 42 

Med. College, South Carolina 51 

Transylvania 62 

Louisville 48 

Willoughby 7 

Med. College, Louisiana 9 
Columbia College, D. C. 



1841-42. 



22 

19 
16 
51 
26 
36 
114 
61 



58 
55 
53 



20 



The above are all taken from official catalogues or Medical Journals, except 
of the Medical College of Louisiana, which were obtained from Prof. Jones, by 
J. S. Wood, M. D., of this city. 

The reader will perceive the incompleteness of the respective tables, but the 
means of supplying this in full are probably beyond the reach of any single in- 
dividual. 

I add the following, as of some interest, from the Foreign Quarterly Review 
of Jan. 1841. 



404 


Jena 


72 


122 


Kenigsberg 


84 


128 


Leipsic 


220 


115 


Munich 


195 


148 


Copenhagen 


142 
T. R. B. 



1842.] American Intelligence, 239 

Number of medical students in the several German Universities at the recent 
conclusion of the academical year. The editors remark that they have been at 
some pains to collect these and other statistics of the universities. 

Berlin 

Bonn 

Breslau 

Halle 

Heidelbersf 



On the Intermittent Fever of New England. By Samuel Forry, M. D. (Ex- 
tract from a letter to the Editor. 

Dear Sir: — Dr. Stephen W. Williams, of Deerfield, Mass., having contro- 
verted, in a communication lately made to you, a statement of mine that appeared 
in an article on "The Endemic Influences of the United States," published in 
your Journal for October last, it is desirable that such an explanation may be 
made as will avoid all subsequent controversy, whilst the ends of Medical Sci- 
ence shall be promoted. Upon this point Dr. Williams evinces the proper spirit. 
In the investigation of a subject so diversified and extended as the medical ge- 
ography of the United States, it requires the combined labours of all who have 
at heart the interest no less of general than of medical science. If every one 
would contribute his mite after the manner of Dr. W., much would soon be 
effected towards determining the laws of nature in regard to the influence of 
external agents upon the healthy and diseased condition of man. 

The error exposed by Dr. W. is found in the following quotation made by 
me from the work of Dr. Joseph Mather Smith on the etiology of epidemics: — 
" On the Connecticut river, from Northampton in Massachusetts to its source, 
a distance of more than 200 miles north and south, and on all its tributary 
streams on both sides for 100 miles in width, there has been no instance of any 
person having contracted the intermittent fever, from the first settlement of the 
country to the present time." This statement, it seems, was first made by 
Professor Nathan Smith in his work on Typhus Fever, and to show its errone- 
ousness. Dr. Williams refers me to Holmes' Prize Dissertation on the Intermit- 
tent Fever of New England,— a work which I take shame in acknowledging 
that I have not before read. Dr. Holmes, many of whose facts were obtained 
by opening a general correspondence by letter throughout New England, proves 
conclusively that intermitting fever has prevailed on the Connecticut river from 
our earliest colonial history. In a letter from Dr. Williams himself, contained 
in this treatise, it is shown that the locality of Deerfield, on the Connecticut, 
which was once the bed of a lake, and subsequently became converted into 
meadows and marshes, was in former years rife with fever and ague. Within 
the last sixty -five years, however, few cases have occurred, and at present it is 
unknown — a result ascribable to the gradual drying up of the marshes. Dr. 
Holmes further proves from historical evidence that, in 1671, fever and ague 
prevailed at Boston, and also at New Haven, on its "first planting." In regard 
to the latter place, the historian remarks that " upon these southern coasts of 
New England it is not annual, as in Virginia, there being sundry years when 
there is nothing considerable of it, nor ordinarily so violent and universal." 

Dr. Holmes' essay is accompanied with a map of New England, exhibiting 
the localities in which intermittents have been at any time indigenous; and the 
fact that but twenty-seven such points, including three on Lake Champlain, are 
laid down over this wide extent of territory, proves of itself the extreme infre- 
quency of the disease. Moreover, one half of these localities are on the Con- 
necticut and Housatonic rivers, which have rich alluvial tracts, whilst along the 
shore of Long Island Sound, between the mouths of these two rivers, a narrow 
alluvialjiat extends. These facts, then, instead of disproving, confirm the con- 
clusion arrived at in my article on " The Endemic Influences of the United 
States," viz. that a region of primary formation^ with a sandy soil and an undu- 
lating surface, is exem.pt from fever and ague. The occasional prevalence of 
this disease in the valley of the Connecticut river, affords, indeed, a happy 



240 American Intelligence. [July 

illustration of the ancient axiom of the exception proving- the rule; for here, 
contrary to the general geological character of New England, we have a secon- 
dary instead of a primary formation. "The valley of the Connecticut," says 
Bradford in his Illustrated Atlas, "is occupied by a basin of secondary rocks of 
about fifteen miles in average width, consisting of red shales, argillaceous 
sandstones, and beds of conglomerates, crossed by numerous dykes and ridges 
of trap." As this formation has an alluvial superstratum, we discover a marked 
geological analogy between this valley and the Atlantic plain on which malarial 
diseases are dominant. 

In my article on "The Endemic Influences of the United States," the follow- 
ing language is used: — " Now as the region of New England, with little excep- 
tion^ has a primitive formation, with a sandy and sterile soil, whilst that of the 
great lakes consists of a secondary formation, having not unfrequently an allu- 
vial superstratum of a rich vegetable mould, from three to six feet deep, it is 
not difficult to deduce the correct inference. In the former, the geological form- 
ation is destitute of organic remains, and the little contained in the sandy soil 
does not find enough of moisture to induce the necessary chemical action; 
whilst in the latter, not only is the geological structure of secondary origin, but 
the deep rich soil is sufficiently humid, when a high temperature acts upon the 
organic remains with which it abounds, for the development of the morbid 
poison, called malaria." Now in adverting to the italicised words, '■'■with little 
exception^'''' does it not afford a striking confirmation of the validity of my de- 
duction, to find by subsequent facts that this excepted portion is the one in which 
fever and ague have always been more or less generated! As this disease is 
no longer known at Boston, Deerfield, and some of the other localities laid 
down on Holmes' map, we are warranted in the belief that the endemic, 
wherever it may have been indigenous in the New England States, is attributa- 
ble to peculiar local causes; as, for example, at Deerfield there formerly existed 
an accumulation of remains in the marshes and meadows formed by the bed of 
an ancient lake. 

In my work on "The Climate of the United States and its Endemic Influ- 
ences," which will be published in a few days, the question of the agency of 
soil in the production of malarial diseases, is still more fully investigated. 

I have the honour to be, very respectfully, your obed't. serv't, 

Samuel Forry, M. D. 

New York, March 1, 1842. 

Nathaniel Chapman^ M. D. — The following sketch of the distinguished Pro- 
fessor of the practice of medicine in the University of Pennsylvania is from our 
cotemporary the Medical Examiner. All who are acquainted with the " present 
head of the profession"* in this country will bear testimony to the correctness 
of the outlines and the perfect justice of the colouring: — 

Professor Chapman is the Sir Henry Halford of the United States. He is 
not more distinguished for professional attainments than for courtliness and 
vivacity of manner, wit, knowledge of the world, and literary taste. His pri- 
vate character forms a marked contrast with that of his late friend and cotempo- 
rary, Physick, with whom he so long shared the first rank in the profession of 
Philadelphia. Physick, who shunned general society, and was little known 
except in professional intercourse, had a reserved stateliness of manner from 
which he never unbent. Engrossed by his patients and profession, he seldom 
entered into the every-day topics of life, and is remembered only as the skilful 
surgeon and successful operator. Chapman's temperament was cast in a differ- 
ent mould. Eminently social in disposition, with a gaiety of spirit that has not 
flagged with years— a wit — a punster — delightful as a companion, and enjoying 

* He was thus enthusiastically toasted at a very large professional dinner in Phila- 
delphia two years since. The first toast was "the memory of the late head of the 
profession, Dr. Physick." On Dr. Chapman, who presided, rotiringr, his health as the 
present head of the profession was offered as a toast, and received with acclamation. 



1842.] American Intelligence. 241 

company, he has, for a long period, occupied a position, we may say unrivalled, 
in the society of this city. To these brilliant qualities he unites the kindliest 
feelings. His wit is without malice, and he is frank, open-hearted, and open- 
handed. It is not, then, surprising that he is individually as popular as he is 
professionally eminent. 

Dr. Chapman was born in Fairfax county, Virginia, on the 28th of May, 
1780, and has therefore nearly completed his sixty-second year. His paternal 
ancestor came to Virginia with the first colony, was a captain of cavalry in the 
British army, and, according to an authentic tradition in the family, was the 
youngest son of a cousin-german of Sir Walter Raleigh. The family settled on 
the river Pomonkey, some twenty miles from Richmond, but the branch, from 
which the doctor is descended, migrated about a century and a half ago to 
Maryland, and fixed itself on an estate on the banks of the Potomac, nearly 
opposite Mount Vernon, which is still in their possession. The doctor's father, 
however, went to Virginia, upon his marriage, where he afterwards remained. 

Dr. Chapman received his early education at the Classical Academy of Alex- 
andria, D. C, founded by General Washington, where he was six years. He 
subsequently spent a short time in two colleges, though not long enough to owe 
either any obligation. He came to Philadelphia in the autumn of 1797, to com- 
mence the study of medicine with the late Professor Rush, of whom he became 
a favourite pupil. He continued three years with Rush, and in attendance upon 
the lectures at the University of Pennsylvania, from which he received his de- 
gree in the spring of 1800. The doctor's thesis was on hydrophobia, written, 
we have been told, at the request of Dr. Rush, in answer to an attack upon his 
favourite theory of the pathology of that disease. Dr. Chapman had, we believe, 
previously prepared another thesis on the sympathetic connections of the sto- 
mach with the rest of the body, which he afterwards read before the Philadel- 
phia Medical Society. This contained the substance of the peculiar views on 
fever and other diseases, as well as the modus operandi of medicines, which he 
has since taught. While a student. Chapman found time to become a frequent 
contributor to the Port Folio, a magazine of some celebrity in its day. His 
contributions, under the signature of Falkland, had considerable popularity. 

In 1801, he went abroad, and spent four years chiefly at Edinburgh and Lon- 
don. He remained a year in London, the private pupil of Abernethy, and 
thence passed to Edinburgh. Edinburgh was then celebrated equally for her 
school of medicine and her literary and scientific society. Students of medicine 
resorted thither, as nov«r to Paris, from all parts of the world. Nearly all our 
American physicians of the olden time, Morgan, Shippen, Knhn, Rush, Wis- 
tar, and many others received their education at Edinburgh. It may be sup- 
posed that Dr. Chapman made the most of his opportunities in the distinguished 
circles of the modern Athens. He was enabled to see not a little of the eminent 
persons of those days, and enjoyed considerable intimacy with Dugald Stewart, 
the Earl of Buchan, and Brougham,* then a fellow student. Before his depar- 
ture from Edinburgh, Lord Buchan gave him a public breakfast, on the birth-day 
of Washington, at which a number of distinguished persons were present, when 
he took the occasion to entrust him with an interesting relic, valuable from a 
double historical association. Lord Buchan had presented to General Wash- 
ington a box made of the oak that sheltered Sir William Wallace after the bat- 
tle of Falkirk, with a request "to pass it, in the event of his decease, to the 
man in his country who should appear to merit it best." General Washington, 
declining so invidious a designation, returned it by will to the earl, who com- 
mitted it to Chapman, to be delivered to Dr. Rush, with a view to its being 
ultimately placed in the cabinet of the college at Washington, to which General 
Washington had bequeathed a large sum. 

* In 1809, Dr. Chapman republished here Lord (then Mr.) Brougham's Speech 
before the House of Commons on the British Orders in Council, with a biographiea! 
sketch of him, in which he predicted his future eminence. Lord Brougham was then 
quite a young man, little known in this country. 

No. VII.—JuLY, 1842, 21 



243 Jlmerican Intelligence, [July 

Dr. Chapraan returned to this country in 1804. He established himself in 
Philadelphia, where he soon afterwards married. His attractive manners and 
reputation for talent secured his almost immediate success in practice. He 
became the favourite physician of a large portion of the higher classes of Phila- 
delphia, and has continued, for more than thirty years, to occupy this position. 
He was the physician and confidential friend of the Count de ^urvilliers, (Jo- 
seph Bonaparte,) during his long residence in Philadelphia and its vicinity. 
From the count he gathered a large fund of interesting anecdote of the illustri- 
ous brother of the ex-king, and the men and scenes of his eventful times, from 
which the doctor occasionally draws. In his day, Dr. Chapman has seen much 
of the prominent statesmen of the United States, and, though never entering 
into politics, he is familiar with the personal history and character of most of 
our public men. He was summoned to the death-bed of General Harrison, 
though too late to assist in the treatment. 

As a practitioner. Dr. Chapman is distinguished as much for the charm of his 
manner in the sick chamber, as for skill and success in prescribing. His lively 
conversation and ever-ready joke are often more effective than anodyne or cor- 
dial. Indeed, in cases of trifling importance, the doctor sometimes prescribes 
little else. In pleasant chit-chat, both patient and physician forget the object 
of the visit, and the doctor will depart and "leave no sign" for pill or bolus. 
But, when roused by symptoms of actual severity. Dr. Chapman is almost une- 
qualled in resources, as he is devoted in attentions. Hence, as a consulting 
physician, his great powers are particularly conspicuous. Rapid and clear in 
diagnosis, inexhaustible in therapeutics, self-relying, never discouraged, never 
*' giving up the ship," he is the physician of physicians for an emergency. 

Dr. Chapman is best known abroad as a writer and a lecturer. Not long after 
his return home, he published a work entitled " Select Speeches, Forensic and Par- 
liamentary ^"^ with critical and illustrative remarks, in five 8vo. volumes, which 
attracted much attention. He has since, however, confined his pen to scientific 
topics. The year of his return, 1804, he gave a private course upon obstetrics, 
which proved so popular, that, in 1806, at the age of twenty-six, he was elected 
adjunct to the chair of Midwifery in the University, and soon afterwards to that 
of the Materia Medica. His colleagues of that day, Shippen, Rush, Wistar, 
Physick, James, are gone, and he remains the senior professor in the Univer- 
sity, and, doubtless, the oldest lecturer on medicine in America. The course of 
lectures on Materia Medica is beyond the memory of the writer of this sketch. 
The views and arrangement adopted by the lecturer may, however, be inferred 
from his " Therapeutics,'''' to which allusion will be made. At the death of 
Rush, in 1812, Chapman was transferred to the chair of Theory and Practice, 
which he has ever since filled. 

The lectures of Professor Chapman, annually delivered to large classes, dur- 
ing a period of thirty years, are of course familiar to no small portion of the pro- 
fession of the United States. We but reflect general opinion, in pronouncing 
them erudite, elaborate, and highly finished compositions, enriched with the 
stores of the most varied reading and of ample personal experience. The pro- 
fessor has, we believe, continued to retain, as the basis of his course, the ori- 
ginal draft at first prepared, although many lectures have been rewritten, and 
the whole often remodelled. Keeping pace with the progress of medical sci- 
ence. Professor Chapman is yet slow to adopt, certainly to give currency to 
what are termed the novelties of the day. On a few subjects, his opinions dif- 
fer from those generally received. His views of fever are of the ultra-solidist 
school, and of course at variance with the prevailing doctrines. It is foreign to 
our purpose, however, to canvass these points critically. Dr. Chapman's deli- 
very of his lectures is animated and emphatic. His voice is clear, not of great 
volume, but so highly pitched as to seem loud. A slight nasal intonation gives 
it a peculiarity, not unpleasatit when the ear has become familiarized to it. 

In addition to his courses at the University, Dr. Chapman for a long period 
gave clinical lectures in the hospital of the Philadelphia Almshouse. He has, 
moreover, for upwards of twenty years, delivered a summer course of lectures in 



1842.] American Intelligence. 243 

the Medical Institute. This institution was founded by Dr. Chapman, although, 
as we learn, he has never participated in the fees, or exercised any control over 
the appointments to the chairs. In days of yore, the doctor was a leading de- 
bater at the Philadelphia Medical Society, when the floor of that society was a 
field, in which the ablest members of the profession met in earnest and often 
vehement discussion. Dr. Chapman has several times filled the honourable 
post of President of the Society. He is now the Senior Vice-President of the 
American Philosophical Society, and has, we believe, been chosen correspond- 
ing member of most of the learned societies of Europe. 

Dr. Chapman's principal work is his " Therapeutics^''^ published in 1817. It 
has gone through seven editions, one surreptitious; but the doctor has since 
refused to have it reprinted, until he finds time to bestow on it a thorough re- 
vision. The " Therapeutics''' has enjoyed a long popularity. It is written in a 
very attractive style, and, as is well known, is thoroughly impregnated with 
most of the peculiar and original views of the author. It is, perhaps, hardly 
necessary to observe, that some of these are not in accordance with the opinions 
of a large portion of his professional brethren — as, for instance, the theory of the 
modus operandi of medicines. 

In 1820, Dr. Chapman commenced the publication of the "Philadelphia 
Journal of the Medical and Physical Sciences," which he continued to edit for 
many years. The Journal was undertaken with liberal views — the doctor never 
receiving a salary for his services. He has since been an occasional contribu- 
tor to different periodicals. A large number of his lectures have been published 
in the previous volumes of this journal — elegantly written and standard mono- 
graphs on a variety of subjects. 

We feel that this sketch does very imperfect justice to one of the brightest 
ornaments of the profession. It has, however, the merit of being executed in a 
spirit of entire candour. 

Observations on some of the signs of live and still birth, in their applications 
to Medical Jurisprudence. By John B. Beck, M. D., Professor of Materia 
Medica and Medical Jurisprudence in the College of Physicians and Surgeons 
of the University of the State of New York. 

"In all cases of alleged child murder, one of the great questions to be estab- 
lished, is the fact of the child's having respired or not. As the signs by which 
this is to be determined are still the subject of much difference of opinion among 
medical jurists, it becomes important to enlarge our existing stock of knowledge, 
by the accumulation of new and repeated observations. With this view, I have 
embraced every opportunity that has been thrown in my way of examining the 
dead new-born subject. The following observations are founded upon the ex- 
amination often such subjects, which I have been enabled to make through the 
kindness of some of my professional friends. To Dr. Wilson, formerly phy- 
sician of the Bellevue Hospital, from which institution many of the subjects 
were furnished, I am particularly indebted. As the circumstances connected 
with the birth of each are known, no doubt or uncertainty can attach to the ac- 
curacy of the conclusions drawn from them. 

Among the tests principally relied on to determine this question, the most 
important are the following. 1. The static test. 2. The hydrostatic test. 3. 
The state of the ductus arteriosus. 

1. The static test. This test is founded on the fact, that the act of respiration 
causes an increase in the weight of the lungs. There are two forms in which 
this test has been applied. The first is by comparing the weight of the lungs 
with that of the body. This is commonly called Ploucquet's test. The second 
is that of taking the absolute weight of the lungs. 

a. Ploucquefs test. This is so called from its having been originally sug- 
gested by Ploucquet. It is founded on the fact, that as soon as respiration 
takes place in the new-born infant, an additional quantity of blood penetrates 
the lungs, in consequence of which, these organs become heavier than anterior 
to respiration. As the weight of the body of the child cannot undergo any 



244 American Intelligence. [July 

change, he sug^gested accordingly, that a comparison of the weight of the body 
of the child with the weight of its lungs, would furnish a test by which to de- 
termine whether it had respired or not. From the few observations which he 
made, he came to the conclusion that where respiration had not taken place, the 
proportion between the weight of the lungs and that of the body, was as 1 to 70; 
while on the other hand, where respiration had taken place, it was as 1 to 35; 
or in other words, that the weight of the lungs was doubled in consequence of 
respiration. A test so beautiful as this, and founded apparently upon principles 
so truly physiological, it was hoped, would aid, very materially, to solve this 
important question. Numerous experiments and observations were accordingly 
made to test its accuracy in actual practice; and the result has been, that while 
some appreciate it very highly, by others it is viewed as altogether uncertain. 
In the ten cases which I have examined, the proportions are the following: 

Children that had respired. Children that had not respired. 

1. 1 : 43 1. 1 : 58 

2. 1 : 35 2. 1 : 36 

3. 1 : 44 3. 1 : 49 

4. 1 : 32 

Average, 1:40 5. 1:50 

6. 1 : 52 

7. 1 : 54 



Average, 1 : 47 
Now the conclusions to be drawn from these observations, are manifestly ad- 
verse to the accuracy of this test. Taking the individual cases, there is not a 
single one of those which had not respired, which reach the proportions laid 
down by Ploucquet, while in the same list, cases 2 and 4 are very nearly the 
proportions laid down for children that have respired. If we take the general 
averages, too, of the cases, we find that they do not correspond with the pro- 
portions suggested by Ploucquet. 

Since the time of Ploucquet, a great number of observations have been made 
by other persons, and as the result, they have all fixed upon different proportions. 
The following are some of them. 

Before respiration. After respiration. 

Schmitt, 1 : 52 1 : 35 

Chaussier, - 1 : 49 1 : 39 

Devergie, - - 1 : 60 1 : 45 

These, as being deduced from a large number of cases, come nearer the true 
proportions than those of Ploucquet, and correspond more nearly with my own 
observations. Still, however, it is to be recollected that they are mere average 
numbers, and therefore do not meet the circumstances of individual cases, which 
of course they ought to do, for the purpose of rendering them practically avail- 
able. It may be asked, then, is this test to be rejected altogether! As an infal- 
lible one, it certainly should be. Notwithstanding this, it is still, I think, valu- 
able as furnishing corroborative proof, and should, therefore, never be neglected. 
It should always be taken in connection with the other signs; and when this is 
done, it may aid very materially in coming to a correct conclusion. 

h. Absolute weight of the lungs. By some it has been supposed, that the ac- 
tual weight of the lungs would furnish another criterion of the fact of respiration 
having taken place or not. Accordingly, an average weight of 1000 grains has 
been proposed for the lungs of a child which has respired, and 600 grains for 
those of a child which has not respired. A moment's reflection, however, must 
convince us that this is still more uncertain than the test of Ploucquet. Chil- 
dren born at the full time, we know, differ greatly in their weight, and of course 
there must be a corresponding difference in the weight of the lungs. I have 
known a child born at the full time, healthy and perfect in every respect, and 
yet weigh only four pounds; while children weighing eight, nine and ten pounds 



1842.] American Intelligence. 245 

are by no means uncommon. The lungs, therefore, of a child which had not 
respired, of nine pounds, would probably weigh more than those of a child of 
four pounds, which had respired; and such has been found to be the case by 
actual observation. In the cases which I have examined, the following were 
the weights. 

Before respiration. After respiration. 

1. 540 grains. 1. 396 grains. 

2. 720 2. 800 

3. 900 3. 814 

4. --.... - 890 

5. 900 Average, 670 

6. 690 

7. 689 

Average, 761 

An analysis of these weights will show at once how fallacious this test must 
be. We have here, in three cases, before respiration took place, the lungs 
weighing more than in those which had respired; while the general average 
weight is greater in those which had not respired — ^just the reverse of what it 
ought to be according to this test. 

2. The hydrostatic test. This testis founded upon the difference in the spe- 
cific gravity of the lungs before and after respiration. In other words, lungs 
which have respired will float in water, while those which have not respired 
will sink. Every observation which I have been enabled to make, has con- 
firmed me in the general accuracy of this test. It is liable, however, to certain 
fallacies or objections which require to be understood, to enable us to make a 
correct practical application of the test. On the one hand, lungs which have not 
respired may float from putrefaction — from artificial inflation — from emphysema; 
while, on the other hand, lungs which have respired may sink from disease, or 
from the respiration being feeble or imperfect. Of these I shall only notice two, 
as they are the only ones, of which illustrations have occurred in the cases 
which I have examined. They are, however, the most important of all the ob- 
jections. 

a. Putrefaction. That the lungs of a child which has not respired may float 
in consequence of putrefaction, although at one time questioned, is beyond doubt. 
The case which I shall presently relate, independent of numerous others, estab- 
lishes this fact. The modes of distinguishing it from the floating of respira- 
tion are simple and obvious, a. By the air bubbles being visible under the 
external covering of the lungs. In vital respiration this is not the case. b. By 
the ease with which the air can be pressed out of the lungs. By simply 
squeezing them in the hand, they can readily be made to sink in water. In 
vital respiration this cannot be done. c. By the sinking of the internal portion 
of the lungs. The air, in putrefaction, forms on the surface of the lungs; and 
hence the internal part, if cut out and put into water, will not float. In vital 
respiration, the internal part will float more readily than the external part of the 
lungs. 

Case. Aug. 25, 1838. A still born child was presented for examination by 
Dr. Wilson of Bellevue Hospital. The child had been born two days before. 
The weather being intensely hot, decomposition had commenced. The body 
was of a greenish colour; the abdomen greatly distended; the skin peeling off 
in several parts of the body. The cord about two inches long, smooth, soft, 
moist and flexible; weight, 31680 grains; length, 22 inches; the umbilicus 
twelve inches from the top of the head — the centre of the body, accordingly, a 
little above the umbilicus. On opening the chest, the surface of the lungs was 
found covered with air bubbles, varying from the size of a large pea to a pin's 
head. On the posterior part of these organs there were no air bubbles. The 
colour of the lungs was dark red, with here and there spots of a lighter hue. The 
lungs taken out of the chest, with the heart and thymus gland attached, floated 

21* 



246 American Intelligence, [J"ly 

in water; separated from the heart and thymus gland, they also floated, as did 
also the latter organs. The weight of the lungs was 540 grains; making the 
relative weight to that of the body as 1:58. A portion of the internal part of 
the right lung being cut out, sank in water. Both lungs were now subjected to 
moderate pressure, and after this they sank in water. Each lung was now cut 
into ten pieces, and on being put into water, some sank, while others floated. 
On being moderately compressed between the fingers, each separate section 
sank rapidly to the bottom of the vessel. The ductus arteriosus was cylindrical 
in shape, and about the size of the pulmonary artery; the foramen ovale open; 
the umbilical vessels and ductus venosus pervious; and meconium in the large 
intestines. 

This case illustrates, very strikingly, the fact that the lungs of a still bom 
child may float from putrefaction, and at the same time confirms the accuracy of 
the tests, by which it may be distinguished from the floating which is the result 
of vital respiration. 

h. Jirtificial inflation. That the lungs of a child which has not respired may 
be artificially inflated, so as to cause them to float, though doubted by some, is 
well established; and when this is the case, it presents one of the most puzzling 
problems — to distinguish it from vital respiration. The only test upon which 
any reliance can be placed, is the application of suitable pressure to the lungs. 
If the floating be the result of vital respiration, no degree of pressure can expel 
the air from the lungs sufficiently to cause them to sink; while, on the other 
hand, in cases of artificial inflation, this can be done. 

Case. Dec. G, 1839. Examined a child which had been still born, but which 
the accoucheur had attempted to resuscitate by blowing into its mouth, but 
without success. Length, twenty inches; the centre of the body at the um- 
bilicus; head full of hair; nails full grown, and the body perfectly sound; 
weight, 47040 grains. No inflammatory circle around the navel; thorax flat. 
On opening the chest, the lungs were found in the upper and lateral portions of 
the chest, leaving the pericardium and diaphragm uncovered. On taking out 
the lungs, the right lung was of a dark red colour, with the exception of the 
lower pari of the upper lobe, and the upper part of the lower lobe, which were 
of a bright red. The middle lobe had alternate patches of bright red and dark 
red. The left lung was dark red, with the exception of the extremity of the 
lower lobe and the posterior part of the upper lobe, which were bright red. 
Distinct crepitus in both lungs in the parts corresponding to the bright patches. 
The weight of the lungs was 900 grains, making the relative weight to that of 
the body as 1:52. Both lungs floated in water. The separate lobes of each 
lung also floated. The right lung was then cut into twelve pieces, all of which 
floated; but all the pieces sank after being subjected to pressure. The left lung 
was cut into ten pieces, and all but one floated. On pressure being made, they 
all sank. The pressure was made by placing them in a piece of strong linen, 
and then twisting and wringing them; after this they were placed under a large 
flat stone. 

The ductus arteriosus was as large as the trunk of the pulmonary artery; 
cylindrical in shape, and much larger than the branches of the pulmonary 
artery. The foramen ovale, ductus venosus, umbilical arteries and veins all 
open. 

This case is exceedingly interesting, as illustrating the effects of artificial in- 
flation, and as showing how nearly they resemble those of vital respiration. 
The floating of the lungs was almost perfect, and the weight of the lungs (900 
grains) was nearly that of the usual average standard of children that have re- 
spired. On the other hand, the sinking of the lungs, after due pressure, the 
relative weight of the lungs and the body, 1:53, and the state of the ductus ar- 
teriosus, were in favour of artificial inflation. 

3. State of the ductus arteriosus. This is also called the Vienna test, 
from its being originally suggested by Prof. Bernt, of Vienna. It is founded on 
certain changes, which take place in the ductus arteriosus, immediately after res- 
piration. In the mature foetus before respiration, this duct is about half an inch 



I 



1842.] American Intelligence. 247 

long, cylindrical in shape, with a diameter about equal to that of the pulmonary 
artery, and more than double the size of the branches of that artery, each of 
which is equal to that of a crow quill. If the child have respired a few mo- 
ments, the duct becomes conical in shape, with its contracted part towards the 
aorta. If the child have respired for some hours or a day, it becomes cylindri- 
cal again in shape, but lessened in length and diameter. It is much less now 
than the pulmonary artery, and not larger than the branches of that artery. If 
the child have respired for several days or a week, the duct will be found still 
more contracted; its diameter will be not larger than a crow quill, while the 
branches of the pulmonary artery are much enlarged to the size of a goose quill. 

The result of my observations goes strongly to support the accuracy of these 
observations. In six still born children, I found the ductus arteriosus cylindri- 
cal in shape, and about the size of the main trunk of the pulmonary artery, and 
considerably larger than the branches of the pulmonary artery — in some cases, 
double the size. In a seventh still born child, I found it nearly of the size of 
the pulmonary artery, but not much larger than its branches. In a child 
which had lived four days, the ductus arteriosus was cylindrical, three lines 
in length, and about the size of a crow quill, and not more than half the size 
of the pulmonary artery. In a child which had lived three days, the ductus 
arteriosus was two and a half lines long and cylindrical; about one third the 
size of the pulmonary artery, and somewhat smaller than the branches of that 
artery. In a child which lived forty-six hours, the ductus arteriosus was one 
fourth of an inch long, cylindrical in shape, less than half the size of the pul- 
monary artery and about equal to the branches of that artery. 

Although the foregoing observations, generally speaking, confirm the accuracy 
of this test, it is to be recollected that it is not to be relied upon in all cases. 
This has been shown particularly by Orfila. 

I have thus, as briefly as possible, recorded the results of the foregoiug ob- 
servations, without indulging in the many comments which naturally suggest 
themselves. I have, however, in another place,* so fully discussed all the 
points connected with this subject as to render them at present unnecessary. — 
Trans. Med. Soc. Stsite of New York, 1842. 

Inversion of the Uterus. — D. Humphreys Storer, M. D., reported to the Bos- 
ton Society for Medical Improvement, April 11, 1842, the following case of 
inversion of the uterus. 

He was called to a woman in labour. In ten or fifteen minutes there came 
two smart pains, and the child was born. In five minutes the placenta was 
thrown off. The cord was not touched, except to divide it and remove the 
child. On putting his hand under the clothes, to take away, as he supposed, 
the placenta, he found that he had hold of the uterus with the placenta attached. 
He removed the placenta, put his fingers to the fundus of the uterus, and passed 
it up without the slightest difficulty. There was some flowing from the uterus 
where the placenta was detached, but not great, and none after it had passed 
up. The woman was very much prostrated, and for an hour appeared as if she 
was dying. She however revived, and the next morning was comfortable. 
This case proves that inversion may take place, without the interference of the 
practitioner. For no traction whatever was made upon the cord, which was of 
the usual length, and not encircling the child. 

Drs. Dewees, Burns and Gouch,in cases of inversion, advise, when it can be 
accomplished, the return of the uterus before the removal of the placenta, on 
account of the dangerous hemorrhage which is otherwise liable to ensue. Dr. 
Bard recommends the previous removal of the placenta. 

Dr. Storer followed in this case the practice of Dr. Bard, and the ease with 
which the uterus was returned, and the happy convalescence thus far, she being 
as well to-day (the sixteenth day after delivery,) as she had been at the same 

* Elements of Medical Jurisprudence, by T. Romeyn Beck, M. D., and John B. 
Beck, M. D. 



248 American Intelligence, [July 

period during any former pregnancy, proves the course to have been a judicious 
one. The placenta was very large, and he believed that had he made any 
attempt to return it, he would have met with difficulty, from its mere bulk. In 
a case of inverted uterus, related by Dr. Meigs, of Philadelphia, in his Practice 
of Midwifery, he was unable to return it with the placenta, and at the sugges- 
tion of Dr. James, the after-birth was removed from its attachments. After- 
wards, with considerable difficulty, a reduction of the organ was effected. 

The little blood which was lost after the placenta was removed, in the case 
reported by Dr. Storer, showed, he thought, that the great dread of uterine 
hemorrhage, which is felt by physicians from the removal of the placenta, even 
should no uterine contraction immediately occur, is not well founded. • As soon 
as the placenta was detached, the hemorrhage ceased, and although the uterus 
was so completely relaxed as to allow the hand to pass with perfect freedom, 
without the slightest muscular contraction being perceived, there was no 
bleeding. — New England Quarterly Journ. of Med. ^ Surg., July? 1842. 

Operation for Artificial Pupil and subsequent section of the Rectus superior. By 
J. Kearny Rodgers, M. D., Surgeon to the N. Y. fiospital. — Francis Ander- 
son, aged about twenty-five years, while engaged on the Albany and Boston 
Railroad, in December, 1838, was severely injured by the explosion of powder. 
The left forearm was amputated; the right eye sunk, and vision nearly destroyed 
in the left. 

September 22d, 1841. He was admitted, under my care, into the New York 
Eye Infirmary, with the hope of regaining the sight of the left eye. There was 
a dense opacity of the lower part of the cornea, occupying two-thirds of its 
whole area, leaving a crescentic upper portion transparent; the greatest width of 
which, was about one-fourth the diameter of the cornea. The iris adhered to 
this opaque part, that had evidently been the seat of a perforating ulcer, or 
slough; and the pupil was drawn downward. On examining the eye from 
above, the edge of the pupil could be seen; and I determined to give him the 
opportunity of any benefit to be derived from Gibson's operation for artificial 
pupil. This was performed on the 26th of September, in the manner recom- 
mended by Guthrie; making an incision through the cornea, with a cataract 
knife, and withdrawing it "with a rip." The iris protruding this wound was 
lemoved by a pair of curved scissors, and the operation completed in half a 
minute. 

No inflammation followed the operation, and vision was greatly improved, so 
as to enable him to see large letters. The upper lid, however, usually covered 
the pupil, and on the 16th of October, for the purpose of raising it, so that its 
edge should not interfere with the pupil, I removed a portion of its integuments, 
(after the ordinary operation for entropion,) with benefit. Still the levator pal- 
pebrae superioris could not raise the lid sufficiently at all times, and the assist- 
ance of the hand was occasionally required. He returned home, however, grati- 
fied with the amendment derived from the operations. 

In March of the present year, he again called on me; and finding that the 
upper lid interfered with vision, I resolved on an operation, which I believe has 
once been performed, in similar circumstances, of dividing the rectus superior 
oculi, and thus allow the rectus inferior to draw down the pupil beyond the 
margin of the upper lid. This was done on the 8th, in the way I ordinarily 
operate for strabismus. The upper and under lids being held by a practised 
assistant, I raise the conjunctiva with blood-vessel forceps, and cut through it 
with straight scissors. The tendon being laid bare, I pass a curved probe under 
it, and divide with a pair of bent scissors. 

Very little inflammation ensued, and the eye was drawn down so as to im- 
prove his vision, but not as much as I expected, and certainly not corresponding 
to the change that usually takes place after the operation of dividing the rectus 
internus in strabismus. He now left me, satisfied with the amended sight, and 
the result of the operation. — New York Med. Gaz., April 20, 1842. 



1842.] American Intelligence. 249 

Rupture of the Uterus from external injury. — The following shocking' ex- 
ample of meddlesome midwifery, is related by Dr. F. Hyde, in the Boston Medical 
and Surgical Journal for I9th Jan. last. 

" On Jan. 1, 1836, Mrs. Arnold, of Freetown, Cortland Co., N. Y., set. 35 
years, who had generally enjoyed good health, had borne several children, and 
was at the full period of utero-gestation, having occasion to step out of the 
house, while walking upon the ice, fell, striking, with the entire weight of her 
body, the anterior of the abdomen, and producing a sensation (to use her own 
phrase), as if she were split open, in the belief of which she was persistent. 
Faintness followed at intervals, amounting to complete syncope, during the first 
twenty-four hours after the injury, with incessant vomiting, coldness of surface 
and extremities, countenance sunken, and a deathlike aspect. The physician 
and friends in attendance supposed the case must be fatal, and had little or no 
confidence in any means which they could adopt. Under these circumstances, 
my partner, Dr. Miles Goodyear, was called, at the end of twenty-four hours 
after the injury had been received. He learned that there had been no motion of 
the child since the fall; patient complained of occasional abdominal pains; os 
uteri not in the least dilated; external appearance of abdomen natural, but ex- 
tremely tender to the touch. Had been no evacuation from the bowels since 
the injury. Enemata were now administered, but not sufficiently retained to 
produce their desired effect. Reaction had now come on to some extent; pulse 
110 and small; tongue thinly coated and dry; mouth of uterus still rigid and 
unyielding. Ordered 10 grs. of protochloride of mercury to be given, and re- 
peated at the end of four hours, and followed by a dose of sulph. magnesia, 
which in the course of five or six hours produced free intestinal evacuations. 
Vomiting not so frequent, general symptoms nearly the same. It was now 
some ten or twelve hours since the arrival of my partner, who advised mild 
febrifuge remedies to be continued, and left the patient in charge of the attending 
physician, who stated that he should recall him on the least change of symp- 
toms. 

" Accordingly, in about thirty-six hours afterwards, he was again called, when 
I saw the patient with him for the first time. We found her with countenance 
more deathly, pulse 120 and more feeble, tongue thickly coated and dry in the 
centre, less vomiting, tenderness of abdomen not so much, and patient did not 
complain of pain in this region, more than of other parts. Bowels had moved 
freely, and evacuations not peculiarly offensive. The general appearance of the 
patient indicated the delivery of the child, if it were ever to be done. But upon 
examination, we found no relaxation or dilatation of the os uteri, nor was the 
least effort on the part of the uterus to be discovered. We now proceeded with 
the steps of a forced labour and delivery of the child. Accordingly, the dilata- 
tion was commenced; a process so obstinately resisted by the unyielding state of 
the parts, as to require from four to Jive hours to effect a delivery of the child. It 
may not be improper to say here, that to produce sufficient dilatation in this case, for 
the accomplishment of the object in quedion, was no very inconsiderable labour, the 
hand of the operator requiring frequent intervals of rest, to enable it to accomplish 
its purpose. The child was large, and dead as was supposed previously, but no 
disorganization had yet taken place, and everything had thus far been accom- 
plished independent of any proper or natural function of the uterus. Profuse 
hemorrhage now came on; the uterus not exhibiting the least contractile effort. 
The hand was immediately returned, detaching the placenta with facility 
until it arrived at the upper and anterior portion of the organ, when it met a 
resistance, which seemed to be a perfectly firm adhesion of the placenta and 
uterus, extending over a surface of from four to five inches, which could not be 
broken up with any prudent exertion. Patient was now much exhausted, 
extremities cold, pulse scarcely perceptible at the wrist, hemorrhage had nearly 
ceased. In this state of things we concluded that any further effort to detach 
the placenta would not only be unavailing, but inexpedient, and to separate the 
detached mass from the adherent portion would be attended with the most immi- 
nent danger. Patient was now placed in bed, stimulants freely given, with 



250 American Intelligence, [July 

frictions upon the surface, and sinapisms to the wrists and ankles. We left the 
patient in care of the attending physician, four days having elapsed since the 
injury was inflicted. 

" At the expiration of twenty-four hours we saw the patient again; there had 
been very little hemorrhage, no movement of bowels, external appearances nearly 
the same as when we left. Patient expressed herself better than she had been 
before during her illness, but still the features were more cadaverous. An 
enema was given, which procured free and dark fetid discharges from the 
bowels. She now began to complain much of pain in the region of the stomach. 
Singultus, and vomiting of a green, viscid fluid, of fetid odor, now came on; 
abdomen more distended, pulse much more rapid and feeble, and the already 
prostrated powers of the system unequivocally told that they would soon sink. 
In a few hours death occurred, it being the sixth day from the time of the ac- 
cident. 

^^ Autopsy sixteen hours after Death. On opening abdomen gangrenous spots 
were to be seen on the inner surface of parietes for four or five inches around the 
umbilicus. Some portions of peritoneum adherent to intestines, while other 
parts were softened in structure. Much fetid gas escaped from the cavity. The 
next thing met with, worthy of note, was a full-sized and properly-formed fcetus, 
with its extremities and body in the same relative situation in which nature had 
placed them in utero. The head and shoulders were lying closely upon the ab- 
dominal parietes, to which a portion of the placenta was adherent, to the right 
and left of umbilicus, extending downwards, and laterally from three to four 
inches, the child lying anterior to all the abdominal viscera. Intestines morti- 
fied at various points. The friends objecting to a removal of the child, the 
facilities for further examination were not as ample as the case demanded. The 
rupture of the uterus occupied its superior and anterior portions, through which 
the child must have escaped, with its own placenta, at the time of the accident. 
Very little blood was found in the cavities, but a considerable quantity of serous 
fluid. It will be recollected that there was no external hemorrhage at the time 
the injury was received, and that there had been repeated evacuations from the 
bowels. It is certain that some contraction must have followed the rupture, 
from the absence of hemorrhage at the time; and that some inflammation super- 
vened on the injury, which produced the adhesions met with in the effort to re- 
move the placenta at the time of the delivery of the child." 

Ligature of the External Iliac Artery. — In our No. for October 1841, p. 524, 
we noticed a case of inguinal aneurism, in which this operation had been suc- 
cessfully performed by Dr. E. Peace. The following are the details of the case, 
as reported by the operator, in our cotemporary the Medical Examiner. 

John Erwin, a seaman, aged 28 years, of robust constitution and of healthy 
parents, was admitted into the Pennsylvania Hospital July 17th, 1841, with in- 
guinal aneurism on the right side. Four months previous to this period, after a 
fall received during a severe and long contested wrestling-match he had severe 
pain in right groin, which however left him in the course of a few days. He 
then continued well for two months, suffering only from occasional uneasiness 
at the knee, at the end. of which time there was a return of the pain in his groin 
— he then observed for the first time a small tumour of the size of a walnut, 
which has continued to increase in size and accompanied with such an increase 
of pain as to have incapacitated him from walking during the last three days. 
The patient thinks that the tumour has increased one-half in size during the last 
seven days. He called upon an apothecary for advice, who applied forty leeches 
and recommended hot poultices. 

LFpon examining the patient on the afternoon of his entrance into the hospi- 
tal, we found a pulsating tumour occupying the course of the right femoral 
artery, extending from one inch above Poupart's ligament to three and a half 
inches below it. The transverse diameter of the tumour was four inches. 

Compressing the aorta arrested the pulsation of the aneurism, but without 
producing any diminution of its volume. 



1842.] American Intelligence. 251 

The skin over the tumour is reddened, pits, and the pain is deep-seated and 
very severe. The inner side of the knee is also the seat of great pain; the whole 
limb is swollen; the sensibility is natural except upon the anterior surface of 
the thigh. No sleep for two nights. Ordered the limb to be slightly elevated, 
and lead-water with laudanum applied to the tumour. A teaspoonful of solu- 
tion of morphia procured him a more comfortable night than he had passed for 
some time. 

July 23d. — Six days have now elapsed since the patient's entrance into the 
hospital. All signs of local inflammation have left him; the skin has resumed 
its natural appearance; the pulsation is not so strong in the tumour, which has 
increased rapidly in size. 

After a consultation with my friend and colleague Dr. Norris, it was deter- 
mined to apply a ligature to the external iliac artery on the following day. 
Ordered ol. ricini §i; also, seventy drops of laudanum to be given two hours 
before the operation. 

July 24th. — Before the medical class, a curved incision, four inches in length, 
with its convexity directed towards Poupart's ligament, was made through the 
skin, commencing at a point one inch and a half above and one inch on the 
inner side of the anterior superior process of the ilium, and terminating half an 
inch above the situation of the external ring. The arteria ad cutem was divided 
and' tied. The tendon of the external oblique was then divided upon a director. 
This brought into view the lower edge of the internal oblique and transversalis 
muscles, which were separated from Poupart's ligament with the handle of the 
scalpel. It was found necessary to divide some of the fleshy fibres of the trans- 
versalis, in order to allow more room for manipulation, as the tumour extended 
further into the iliac fossa than we supposed. The peritoneum was easily raised 
up, and the artery was felt beating distinctly, but faintly, contrasting forcibly 
with the violent vibration of the tumour. The artery, which appeared healthy, 
was separated from the vein by the finger nail, and a round silk ligature was 
applied with great facility, by means of the excellent aneurismal needle invent- 
ed by Professor Gibson of this city. The ligature was applied as high as pos- 
sible, so as to allow sufficient space for the formation of a coagulum above the 
epigastric artery, and both ends of the ligature were allowed to remain hanging 
from the wound, to serve as a drain. The pulsation of the tumour was imme- 
diately arrested. ' The lips of the wound were brought together by two strips of 
adhesive plaster, and dressed with lint spread with cerate. The patient made 
no complaint, during the operation, which occupied eighteen minutes, but at its 
termination, his countenance assumed great distress and anxiety. He was car- 
ried to his bed; his limb slightly elevated. The pulse before the operation was 
eighty; immediately afterwards seventy-six; the thermometer ninety-four, being 
the hottest day of the season. 

1 o'clock. — Toes of right foot cold and moist; the rest of the limb warm. 
Two hours afterwards, the coldness extended up to the instep; temperature of 
both limbs the same; pulse sixty-six. 

6 o'clock, P. M. — Pain of the whole limb; florid; pulse seventy-four; skin 
moist; thirst; no extension of coldness above instep, where the sensibility is 
very obtuse. Ordered sol. morph. ^ij; iced barley water. Foot enveloped in 
carded wool. 

Sunday, 11 A. M. — Slept well for two hours and awoke in a fright; pain of 
groin intensely severe; hot fomentations, and sol. morph. ^ij, gave much relief 
— this morning the pain is moderate; pulse seventy-six; temperature of room 
eighty-eight— between toes of right foot eighty-six— right thigh ninety-six — left 
thigh ninety-three. Ordered oat-meal gruel and toast-water. 

10 P. M. — Pain occasionally darts through the tumour — same relative diflfer- 
ence of heat as in the morning. Ordered sol. morph. ^i. 

26th, 11 A. M.— Slept well the whole night. Pulse seventy; skin moist; 
expression natural; difference of temperature still in favour of right limb; sen- 
sibility of the limb improving, but less at the anterior and inner side of the 
thigh. The warmth of the foot has returned as low as the toes. 



252 American Intelligence. [July 

27th. — Slept well; both limbs of same temperature; sensibility natural every- 
where, with the exception of last phalanx of right toes, which remains cold. A 
small red spot at the inner side of patella is very painful, prominent and soft; 
the tumour is also painful and inflamed. Ordered evaporating lotion; sol. 
morph. 5i. 

28th. — No sleep; urination frequent during yesterday, and every fifteen mi- 
nutes during the night; knee less painful, also the tumour, which is now evi- 
dently smaller; the skin wrinkling and pale. Ordered flaxseed tea and a large 
cataplasm over pubic region. 

29th. — Passed a comfortable night; has urinated but twice since yesterday; 
feels perfectly well, with the exception of some uneasiness of right limb. Exa- 
mined the wound which is suppurating freely. Two-thirds of the incision have 
united by the first intention. Left the wound open, as it is closing too rapidly, 
and made use of a simple dressing. The ligature of the superficial artery came 
away. 

No dejection since the operation. Ordered a common enema, which pro- 
duced a copious and healthy evacuation. 

August 3d. — Wound healthy; the tumour diminishes in size and is firmer; 
the oedema of limb entirely gone. 

The patient continued to improve without any unpleasant symptoms; the aneu- 
rism becoming smaller and firmer till August the 24th, thirty days after the 
operation, when the ligature came away, having a large loop. The wound is 
now closed with the exception of the point whence the ligature issued. 

September 15th. — The wound not yet closed; probed it, and found a sinus ex- 
tending an inch and a half in depth. Enlarged the sinus, filled it with lint, and 
applied a poultice. 

22d. — Wound cicatrized, tumour lessening daily and quite firm. 
SOth. — Tumour half of its former size. The patient walks about his room, 
and can bear his whole weight upon the affected side. 

November 24th. — Discharged from the hospital; is able to return to his work. 
The tumour is now about the size of a walnut. 

A month afterwards came to see me, preparatory to his going to sea as mate 
of a vessel, perfectly restored. 

Remarks. — Owing to the rapid progress of the aneurism, it was not deemed 
proper to apply pressure above the tumour with a view of dilating the col- 
lateral branches, as recommended by several eminent surgeons; and it may be 
well questioned whether the benefit resulting from dilatation of the vessels which 
are to nourish the limb will ever compensate for the greater danger incurred by 
an increase of the tumour and inflammation of the surrounding tissues. The 
same reasons may be urged against the recommendation to promote a cure by 
pressure over the tumour; as was practically exemplified in a case of inguinal 
aneurism reported by Dr. Post in the Amer. Med. and Physical Register, (New 
York) vol. iv, where the patient, apprehending more from an operation than from 
the disease, refused the application of a ligature. 

His surgeon then directed the application of a compress and bandage to keep 
up a constant and moderate pressure upon the tumour. Under this treatment the 
aneurism diminished for a time, but then increased rapidly, while severe pain 
and considerable local inflammation, and tumefaction of the upper part of the 
thigh supervened. These symptoms were finally relieved by a removal of their 
cause, and a resort to cold applications and evacuants. When the patient at last 
submitted to an operation, it was found impracticable to separate the peritoneum 
— which is ordinarily so easy — owing to the adhesions that had taken place be- 
tween that membrane and Poupart's ligament from the previous inflammation. 
The surgeon was obliged to cut through the peritoneum in order to apply the 
ligature; consequently, the patient was exposed to the additional hazard of in- 
flammation of that membrane. Fortunately, the termination of the case was 
favourable. ; 

The next point of consideration was the propriety of applying one ligature ' 
or two. Owing to repeated failures when but one ligature is applied, some mo- 






1842.] America^, Intelligence. 253 

dern surgeons have recommended a return to the old method of securing the 
artery above and below the tumour. Whether the greater certainty of prevent- 
ing a return of the circulation by these means makes up for the increased danger 
of a double operation, can only be tested by statistical information which is not 
easily obtained, this difficulty resulting from the small number of cases that 
have occurred in the practice of any one surgeon or at any one place and from 
the suppression of unsuccessful cases. With a view of contributing to the 
amount of knowledge bearing on this question, the experience of this city is 
here given. The ligature of the external iliac, for aneurism of the femoral 
artery, has been successfully performed by Dr. Dorsey in 1811; by Dr. Ran- 
dolph in 1825, and in the third case by Professor Horner at the Blockley Hos- 
pital, where two ligatures were applied and the sac opened. The particulars 
of this case, the termination of which was unfavourable, will be soon reported. 
The shortness of this catalogue shows the extreme rarity of the disease. Re- 
collecting that even a return of the pulsation does not necessarily prevent the 
formation of coagula and a final cure, it appears to be most prudent to trust to 
one ligature in aneurisms of the first class, whilst in smaller vessels, where there 
is but little danger of a fatal termination, two ligatures will more certainly pre- 
vent a return of the circulation. 

It has not occurred in any prior case that I have noticed, that the tempera- 
ture of the limb operated upon has been greater than that of the sound limb, 
immediately after the operation. This difference of heat in favour of the unsound 
limb continued for three days, nor was it at any time reversed. Dr. Neil, who was 
residing at that time in the hospital, kept an exact observation of these facts, as 
well as myself. They exemplified in a remarkable degree the importance of the 
capillary circulation, and the power of the collateral branches, to compensate for 
obliteration of the main artery; and they would lead us to suspect that, in this 
case, the impetus of the circulation had been diminished by a partial formation 
of coagula. This would explain why we were unable to reduce the size of the 
tumour when we arrested the pulsation by pressure upon the aorta, and the sin- 
gular feebleness of the pulsation in the artery which was remarked when the 
ligature was applied. 

With the exception of the irritation of the bladder on the fifth day, no unplea- 
sant symptoms of any kind occurred during the whole course of treatment, which 
was unnecessarily prolonged by the ligature not having been tied sufficiently 
tight. This was manifested by the large size of the loop, and it satisfactorily 
accounts for the retention of the ligature for thirty days. 

Excision of a large Tumour upon the Nech, By R. D. Mussev, M. D., Prof. 
Surgery in the Medical College of Ohio. — In December, 1841, I was consulted 
by Mr. Jas. C. M'Dowell, setat. 34, of Mt. Carmel, Wabash Co., Illinois, on 
account of a large tumour on the right side of his neck, and received from him 
the following account of it. 

The tumour commenced eighteen years ago, in the form of a lump, below the 
tip of the ear, of the size of a hazelnut, which was painful, and which, on that 
account, was thought to be mumps. The pain subsided in a few days, but the 
swelling and hardness remained. From that time the progress of the tumour 
was slow, and almost always without pain, till within the last eighteen months, 
during which time he had experienced a great deal of pain in the ear and on the 
side of the face. In 1828, between five and six years after the first appearance 
of the disease, and when the tumour was about the size of a hen's egg^ 
he came to Cincinnati and took advice from the Professor of Surgery in the 
Medical College of Ohio, who declined operating, saying, " that the carotid 
artery must first be tied, or the extraction of the tumour would prove fatal in a 
few minutes; and besides, the right side of the face would be palsied by the 
division of an important nerve," &c. 

The tumour presented, at the time above mentioned, viz. Dec. 1841, the 
following appearances. — It was nearly hemispherical in form with some tubero- 
sities, extending from the lower part of the concha of the ear, which it crowded 
No. VH.— July, 1842. 22 



254 American Intelligence. [J"iy 

a little upward, to within an inch and three quarters of the clavicle, and antero- 
posteriorly from the anterior border of the cervical portion of the trapezius, to 
within two inches of the median line upon the chin, coverings part of the larynx 
and trachea, and a large portion of the lower jaw. A line stretched from the 
anterior to the posterior edge of the base of the tumour, over its apex or pole, 
measured ten inches; and its circumference at the base was seventeen inches. 
The sterno-cleido-mastoid muscle was put in a state of tension upon the back 
part of the tumour, and seemed adherent to it. This large mass possessed a 
good degree of solidity, had no uncommon sensibility to the touch, could be 
made to glide slightly in the antero-posterior direction, showing that it did not 
involve the deep and large vessels, and most important nerves of the neck: the 
integument covering it was healthy looking. 

I decided upon the practicability of its removal, and put the patient upon a 
farinaceous diet, with water only for his drink; and on the 11th of January, 
1842, in the presence of several professional gentlemen, and a few friends of 
the patient, proceeded to the operation. The integuments and platysma w^ere 
divided by a vertical and a horizontal incision crossing each other at right angles 
upon the pole of the tumour; the flaps were carefully raised, and the mass slow- 
ly disengaged from the condensed cellular bands which shot from the neigh- 
bouring parts, and from the mastoid muscle, a portion of the attenuated edge of 
which was removed. Some difficulty was found and a good deal of pain pro- 
duced in detaching it from the infra-auricular and infra-maxillary tissues, but no 
important blood-vessel was wounded or muscle mutilated, except the mastoid; 
nor nerve injured, except a descending branch of the facial, by which a slight 
displacement was given to the integuments of the chin. The angle of the mouth 
kept its natural position. There was less than a pint of blood lost, and the 
patient, though somewhat faint for a short time during the operation, causing a 
little delay, had so far rallied as to be comfortable during the application of the 
dressings, and after he was carried to his bed. The following night he was 
restless and had considerable pain with irritative fever, which were soothed by 
an anodyne dose with spiritus mindereri. 

After the first night Mr. M'Dowell was comfortable — the wound healed kind- 
ly, and in four weeks he left the city to visit his friends. Within the last few 
days we learn by a gentleman directly from his residence, that he is in sound 
health and good spirits. 

For the purpose of safely extracting large tumours from the neck, it can 
rarely be necessary to ligate the carotid artery as a preparatory step. By car- 
rying the dissection close to the morbid growth but little risk is incurred, unless 
in the fungoid growths, which sometimes completely encircle large vessels and 
important nerves; and with these there is but little encouragement for an ope- 
ration. 

The slow progress of the tumour, together with its solidity and freedom from 
irritation, served to mark it as a morbid structure of mild character; and yet 
from the frequent and strong pains induced by mechanical tension of sentient 
nerves in its neighbourhood during the last year and a half, it might ultimately 
have kindled up an action, the result of which would be obstinate or incurable 
ulceration; but, as it is, the operation will almost certainly be followed by entire 
exemption from the disease. 

The superficial portion of the parotid gland was not to be observed distinct 
from the tumour; indeed there was no obvious trace of any part of it remaining. 
Like most tumours of slow growth, occupying the site of the parotid, it com- 
menced, in all probability, in a lymphatic gland, and by pressure during its 
progressive and protracted enlargement, it had caused an entire absorption of so 
much of the parotid as came in its way. — Western Lancet^ May 1842. 

Thymic Enlargement. — Dr. W. C. Roberts, in an interesting article on this 
subject, in the New York Medical Gazette, (April 6lh and 13th, 1842,) gives the 
following statements relative to the weight and size of the Thymus gland. 

" I am indebted to Dr. Archer for the two following measurements. 



1842.] 



American Intellis^ence. 255 



"1st. Child at full time, had only breathed a few times, length, 21 inches: 
width, 2^ inches; weig'ht, 168 grains. 

*'2d. A child weighing 'plump' 12 pounds, of uncommon development, sup- 
posed to be about two days old, which died, as is supposed, from exposure. 
Length, 2 J inches; width, 1^ inches; weight, ^iiiss. or 210 grains. It was 
exceedingly full, owing to the presence of a great quantity of thick, viscid fluid, 
and of a bright red colour. I'he reader will please to observe that in this very 
fair case, to estimate the normal weight of the gland at birth, it weighed half a 
drachm less than the average quantity stated by Sir A. Cooper. 

"3d. Seven months foetus. Length (extreme) 3 inches, from the tip of the 
longest cornu, to the tip of the longest lobe; width, 1^ inches; weight, 84 grains. 
It was very flat, and of a pale rose colour. 

*'To the attentive kindness of Dr. Darling, late of the Bellevue Almshouse, 
I add the followinsf table: — 



1. 


Stillborn. 


Length 


, n in. 


Width 


1t\ 


in. 


Weight, 


100 grs. 


2. 


do. 


(( 


n 


(( 


n 




ii, 


176 


3. 


do. 


Ik 


n 


(» 


n 




(( 


196 


4. 


do. twins. 


It 


3t\ 


(i 


n 




a 


133 


5. 


2 hours old. 


(i 


n 


(( 


n 




(( 


200 


6. 


56 hours old. 


(( 


ii 


(( 


lA 




(( 


60 
















(died of Cyanosis!) 


7. 


5 days old. 


(( 


n 


u 


IrV 




i( 


47 










(Supposed" to b( 


3 an 8 month 


s child.) 


8. 


7 » 


(( 


2^ 


(t 


If^ 




a 


56 



"In addition to the 11 cases thus recorded, the maximum weight of which is 
210 grains, and that, connected as I think, with an hypertrophied state of the 
organ, I liave reported, in the 11th No. of this Journal, five others, the greatest 
weight of any of those being (at 5 months) 223 grains. In the same Journal, 
also, I have mentioned a sixth which appeared to me both extremely hypertro- 
phied and inflamed, which weighed six drachms. The results of these 16 mea- 
surements, and particularly that of the second case, sent me by Dr. Archer, do 
not tend to support the idea that the thymus gland, at birth, weighs 240 grains^ 
as stated by Hangstedt, Cooper and others. 1 am much more disposed to con- 
cur with the 'reviewer of Hangstedt's paper in the Medico-Chirurg. Review, 
April, 1834, that its weight at birth is from 120 to 180 grains.' " 

Dr. Roberts also relates the following case, in which he considers that the 
fatal result was due to enlargement of the thymus, and which we transfer to our 
pages, as everything calculated to in any degree elucidate the actual influence 
of that state of the gland and the symptoms to which it gives rise, is worthy of 
attention, though we must confess that we cannot regard the case in the same 
light that Dr. R. does. 

" March 18, 1842. Was called to see Henry Duffy, coloured, aged two years 
and one month. He was lying on his mother's lap somewhat exhausted appa- 
rently, by vomiting, during the previous half hour. The skin was not very hot 
nor the circulation hurried, and he was perfectly rational. On being raised to 
the erect position, the vomiting was immediately renewed. Some mucous fluid 
and some particles of ham, were among the matters vomited. The history 
which I received of this case at the time and subsequently, was as follows. He 
was stout, and had been well all winter. Up to this time he had had nothing 
of a bowel complaint; his stools had been figured and healthy, and he had had 
two of that character on the day that I saw him. He had never been known to 
have any fits, or strangling, was not short breathed, never crowed, or held, or 
caught his breath, and had never been noticed to assume any chancre of colour. 
The only thing which could be recollected was, that occasionally he made 
repeated, successive and painful attempts at swallowing. 

"For a week past, succeeding the death of a sister, he had appeared worri- 
some and dispirited, had a slight catarrh, and evinced a constant disposition to 
be out of doors all the time. He awoke, on the day I saw him, as well as 



256 American Intelligence, [July 

usual, breakfasted on some tea and a small piece of fried ham. In the forenoon 
he also ate a small piece of raw carrot. About noon he went out with his mo- 
ther; returned in half an hour, and then pointed to his throat, saying, " mammy 
— hurts me," soon after which he vomited and ejected the carrot. After this he 
went a little distance to a grocery store, and on his return vomited again, and 
continued to do so during half an hour, when I was called to him. A gentle 
emetic was now given him. At half past four, P. M., he seemed much the 
same. The emetic had operated, and he had one evacuation wholly mucous, 
and of extreme fetor. Soon after I left he began to worry and call for drink 
repeatedly; thebreathing become quick, the heart began (so his mother says) to 
beat rapidly, and he grew very hot. Such was his condition at six P. M., when 
I saw him. He was then asleep, but awoke on my entrance perfectly rational, 
and asked for drink, for which, as he had been taught, he immediately returned 
his thanks. Five grains of calomel, to be followed by senna inf., was ordered 
with tepid sponging, the pediluvium, &c. At 12 M., I was again sent for, and 
told he was dying. He was, though perfectly intelligent, evidently much ex- 
hausted, occasionally closing his eyes and opening them again, and asking for 
drink which he consumed greedily. I could discover no symptom indicative of 
cerebral disease; the respiratory murmur was present in both lungs, and the 
belly soft and not tympanitic or tender; the action of the heart was very rapid 
and diffused, the pulse also rapid, but feeble; pulsation was very distinct in epi- 
gastrio, and the skin hot. The respiration 56 (I think), abdominal, but silent, 
or at least, not loud. After the most careful consideration, I found myself 
utterly at a loss to form an idea of the nature of his case, but imagined that 
some disease existed within the intestines. An enema was given which brought 
away only some of the before-mentioned very fetid mucus, which exactly resem- 
bled that expectorated in bronchitis. There was no trace of bile or faeces. 
There had been no more vomiting since half past four P. M. I blistered the 
belly and ordered wine whey, and spir. minder, alternately, and left him at half 
past two A. M. of the 19th. The rapid action of the heart, and heat of the 
skin continued, as I am told, to the last, and he continued asking for drink till 
an hour and a half before he died. In the course of this period, he had four 
short convulsions (lasting half a minute) and after the occurrence of the first of 
these, he did not succeed in speaking intelligibly, though he repeatedly tried, 
and seemed to have his senses perfectly, and to know all around him. In the 
intervals between the fits, his breathing was very rapid and could be heard into 
an adjoining room, and he had occasional slight twitchings of his whole body. 
A curious circumstance is yet to be mentioned. A little before he died he 
attempted to raise himself in bed, and being assisted, looked round and put his 
hand to his mouth, as if wanting to eat. His mother then gave him some 
pieces of cracker, which he chewed and swallowed ravenously. Twice he put 
a piece into his mouth with his own hands. Thus he continued swallowing 
eagerly everything that was given him, until just before he died, which was at 
half past five. During this time his eyes were open, though he closed them 
occasionally, his breathing was short, and his heart beat violently. And his 
mother, an intelligent woman, believes that his faculties remained unimpaired 
to the last. Latterly he moaned a good deal, had a little mucous rattle, and I 
suspect, died rather abruptly, having lived 17^ hours from the period of his 
attack. 

"I have been particular in relating these apparently trivial circumstances, in 
order to show that there existed no ground for any suspicion of cerebral diffi- 
culty. On this account I did not think it necessary to examine the brain at the 
autopsy, which was made in the course of the day, and in which I was kindly 
assisted by Dr. James McOune Smith. On opening the belly, we found the 
spleen, bladder and kidneys healthy. The liver had also a healthy appearance, 
save that on its upper surface there were some tawny spots. The gall-bladder 
was excessively distended with dark olive bile. The mucous membrane of the 
stomach was of a light sienna colour, perfectly free from any trace of redness, 
and the mucous membrane of the intestines appeared sound throughout in colour' 



1842.] American Intelligence. 257 

and consistence. But from the lower end of the ileum to the termination of the 
rectum, the mucous follicles in a state of hypertrophy, though not ulcerated, 
existed to an extent which I have never before witnessed, and many of Peyer's 
plates, of varyipig sizes, were enlarged and mamillated, as if made up of a con- 
geries of mucous follicles. I really believe that every mucous follicle in the 
large intestines was enlarged, yet there were no traces of vascularity on the 
surface of the membrane, nor w^ere the mesenteric vessels congested. The 
glands were much enlarged, but firm. 

"The heart and lungs I removed, and submitted to be examined by my friend 
Dr. Swett, and I have his authority for saying, after a most careful inspection, 
that the lungs and bronchi were perfectly healthy^ the foramen ovale was entirely 
impervious; the left ventricle of the heart was slightly hypertrophied, its walls 
being half an inch in thickness, but no other abnormal condition of it existed. 
The Thymus Gland he considered to be at least twice its natural size. It en- 
tirely covered the anterior surface of the heart to within one quarter of an inch 
of its apex, having but one cornu (right), which extended up for an inch and a 
half upon the trachea. The thymus adhered very firmly to the pericardium. 
Its extreme length was four and a half inches; its breadth, two and a half inches; 
it weighed 285 grains. 

"Excluding the idea that this child died of cerebral disease, or pneumonia, 
and that the heart was sufficiently diseased to have been the cause of death, we 
are naturally led to inquire into the cause of this suddenly fatal result. It had, 
it is true, an extreme development of the mucous follicles, but this must have 
existed for some considerable time before, and the symptoms which accompa- 
nied the attack were certainly not those of follicular enteritis. Is it not then 
reasonable to conclude that the indigestion of the morning's meal induced a gas- 
tric irritation which was extended by sympathy to the heart; and that then the 
thymus, which had undergone since the time of birth no diminution, and was 
consequently, for the age of the child, in a state of hypertrophy, produced its 
peculiar obstruction, and that death, with its usual phenomena, resulted there- 
from? The gland in this case, compared with others, was small. It was 45 
grains larger at two years, than at birth, and though I do not contend that it 
was either congenitally enlarged, nor that it had grown much morbidly after 
birth, I conceive that the case gives support to the opinion I formerly expressed, 
that the not undergoing diminution from the natural size at birth, exposes the 
child to danger at any subsequent period. Notwithstanding its comparatively 
small weight and breadth, the heart was as completely covered by it as in any 
case I have seen, and probably, therefore, its functions as much interfered with. 
The heat of skin which the child had, is mentioned neither by Hoffman, nor 
Hamilton; but it existed in my first, third, and fourth cases. The rapid respira- 
tion mentioned by me, in my first and second cases, and considered by Dr. Lee, 
to be ' too common in infants, to be viewed as diagnostic of anything in parti- 
cular,' which so/ora6/3/ struck Doctors Hamilton and Hoffman (see their cases) 
existed in this case, and was really, almost the only morbid symptom; certainly 
the chief alarming one. It led me, in thinking the case over afterwards, to 
entertain the probability that it might prove to be a case of thymic asthma, so 
strongly, as to induce me to say so to Dr. Smith before making the autopsy. 
It led Dr. Hoffman to his diagnosis; in Dr. Hamilton's case there were 93 
respirations in a minute; in my second case it was like the quick pantings of a 
dog, and attracted the attention of every one, and therefore, with great deference 
to the accomplished reviewer of my humble labours, I would suggest that there 
is ''one thing in particular^ of which it may be * diagnostic,' and venture to 
repeat my previous assertion, that ' the sudden invasion of extraordinarily rapid 
breathing, and of forcible pulsation of the heart, in a child previously healthy, 
or labouring under slight bronchitis, &c. only, ought to lead us to suspect the 
existence of an enlarged thymus gland.' Speaking of his patient, Dr. Hamilton 
says ' that he swallowed water freely fifteen minutes before he died and seemed 
conscious.^ " 



258 American Intelligence. [July 

BlepharnplasHc operation for Ectropion. — Dr. A. C. Post relates, in the New 
York Med. Gaz. Jan. 19th, 1842, an interesting case of successful operation 
for ectropion from a burn. 

The subject of it was a boy seven years of age, who had the left side of his 
face badly burned about three years ago, in consequence of his clothes taking 
fire. When the sore healed, there was left a hard wrinkled cicatrix of a red- 
dish colour, drawing down the lower lid, and occasioning an eversion of its 
whole internal surface. The conjunctiva of the lid which was thus exposed to 
the air, was dry, and resembled in its appearance the integument covering the 
vermilion border of the lips. The margin of the lid was much elongated. 

On the 5th June, 1841, at 2 P. M., Dr. P. performed the following opera- 
tion, assisted by doctors J. Kearny Rodgers, Blakeman, Trudeau and Buel. 

I first made an incision immediately below the everted lid, by which I de- 
tached it from the cheek. I then cut out out a V shaped piece from the lid, and 
brought the edges of the incision together with a suture, by which the tarsal 
edge of.the lower lid was brought into apposition with the corresponding margin 
of the upper lid, leaving, however a considerable chasm between the lower lid 
and the cheek. I then dissected a vertical flap from the integument covering the 
anterior edge of the masseter muscle, about two inches in length and five- 
eighths of an inch in breadth, leaving it attached at its upper extremity by a 
neck three-eighths of an inch in breadth. The flap was then brought around so 
as to fill up the chasm between the lower lid and the cheek, and was secured in 
its place by ten sutures. The sides of the wound from which the flap was 
taken, were brought together and secured by three sutures, fortified by adhesive 
straps. The only situation in which the sides of the wound were not brought 
into contact, was at the angle below the twist in the neck of the flap. A piece 
of lint dipped in iced water was applied over the wound, and directed to be mois- 
tened as often as it became dry or ivarm. 

8 P. M. The patient appears cheerful; there is no pain or swelling about 
the wound. 

June 6th. The flap appears red, but there is no pain or swelling. 

June 1th. He complained in the afternoon of some pain in the wound; but 
everything appears to be going on favourably. 

June 9th. Removed three of the sutures. 

June 10th. Removed three other sutures. Union by the first intention has 
taken place around the greater part of the flap; but suppuration has occurred at 
the extremity towards the nose. 

June llth. Removed all the remaining sutures; found that union had taken 
place throughout the whole wound, except at three points, viz.: the angle below 
the twist in the neck of the flap, the junction of the extremity of the flap with 
the side of the nose, and the inferior angle of the part of the wound from which 
the flap was taken. 

June 20th. The wound has healed throughout its whole extent. The ever- 
sion appears to be entirely cured. The patient has the full power of opening 
and closing the lids. The twist at the neck of the flap is almost entirely ef- 
faced: but the outer canthus is crowded somewhat towards the nose, so as to 
make the aflTected eye appear smaller than the sound one. 

Snakebites. — Prof. Drake, of Louisville, wishes physicians to communicate to 
him such facts concerning the bites of our venomous snakes, as may have fallen 
under their own observation, or that of persons qualified to observe. He is es- 
pecially desirous of learning whether the symptoms produced by the bite of the 
rattlesnake, the copper-head, and the prairie rattlesnake, are the same; whether 
there is an annual recurrence of any of these symptoms; and to what extent 
confidence should be placed in the efficacy of those native plants which have 
been recommended as antidotes. 

We invite the attention of our readers to this request, and hope that they will 
aid the cause of science by communicating any facts in their possession of the 
kind desired. 



1842.] American Intelligence. 259 

Medical Schools of the West. — Next winter, there will be seven Medical 
schools in operation in the Valley of the Mississippi and the Lakes. They be- 
loncr to four States, as follows: In Kentucky — the Medical Department of Tran- 
sylvania University, and Medical Institute of Louisville; in Ohio, the Medical 
College of Ohio, and Willoughby University of Lake Erie; in Missouri, the 
Medical Department of Kemper College, and the Medical Department of the 
University of St. Louis; in New Orleans, the Medical College of Louisiana. — 
The Western Journ. of Med. ^ Surg. June, 1842. 

Assistant Surgeons in the Navy. — We learn that of thirty-two candidates lately 
examined for assistant surgeons in the navy, fifteen only passed the ordeal. 

The following is the list of the successful candidates, classed according to 
their relative merits. 1. Wm. S. Bishop; 2. Samuel M. Edgar; 3. Joseph 
Wilson, Jr.; 4. Charles Eversfield; 5. E. K. Kane; 6. Edward Hudson; 7. 
Richard McSherry; 8. Wm. Pitt Canning; 9. E. J. Bee; 10. J. L. Burtt; 11. 
J. T. Barton; 12.' A. C. Holt; 13. James Hamilton; 14. Charles H. Oakley; 
15. R. N. Baer. 

Medical ^Advertising. — We observe the following article in our cotem- 
porary the Medical Examiner for April 9th, 1842. 

" We accidentally noticed the subjoined advertisement in a late Richmond 
paper: — 

* Radical Cure of Strictures of the Urethra — Dr. adopts this method of 

informing persons labouring under Stricture of the Urethra, that he is success- 
fully treating that troublesome and loathsome disease upon an entirely new plan 
of his own invention — and that he will warrant perfect and speedy cures in every 
case — even the most aggravated and complex, which may be confided to his 
care. 

iXT* Consul tat ions with Dr. — , in cases of Stricture, by letter or other- 
wise, will be confidential. 

, C. H., Va., Jan. 8th, 1842.' 

" Our readers will be surprised to learn that thsi singular advertisement pro- 
ceeds from a surgeon of considerable eminence, well knovt^n as a frequent con- 
tributor to the pages of the American Journal. Had it not come from one whose 
example must exert some influence upon the younger members of the profession, 
we should have passed it without notice. As it is, we think it the duty of journ- 
alists to express the general feeling of the profession in justly condemning such 
advertisements: they are, to say the least of them, entirely unprofessional." 

We do not know who is the Surgeon alluded to in the above notice, but 
we must say that we feel deeply mortified that any one of our contributors 
should have authorized the publication of such an advertisement as the 
above, and we do not hesitate to avow our own views on this subject to 
be in entire accordance with those of our cotemporary. Indeed we have 
already expressed such opinions (see our No. for Oct. 1841, p. 512) in 
noticing some resolutions adopted by the East of England Association; and 
as further evidence that these are the general sentiments of the profession, 
we call attention to the following section of the constitution of the recently- 
formed association in New York for the relief of the widows and orphans 
of medical men. 

" Sec. 8. No person shall be admitted a member of this society who publicly 
advertises any medicine as a secret, or who publicly advertises to cure any dis- 
ease." 

Medical College of Ohio. — The trustees of this school have given notice that 
the chair of Theory and Practice of Medicine having become vacant by the 
resignation of Prof. Kirtland, they will receive applications for the same until 



260 American Intelligence. 

the 15th of July. Letters on the subject to be directed to D. K. Este, Esq. 
Cincinnati. 

A popular Treatise on Vegetable Physiology: with numerous wood cuts. — This 
volume was published in London under the auspices of the "Society for the 
Promotion of Popular Instruction," and it has been republished in this country 
by Messrs. Lea & Blanchard in consequence of their "feeling assured that it 
will be found sufRciently simple in its character, and clear in its explanations, 
to be regarded as an elementary treatise, adapted to those who have no previous 
knowledge of the subject; whilst its systematic arrangement, and the scientific 
value of the principles laid down in it, render it an excellent introduction to 
more comprehensive works on the same subject. The general reader, who seeks 
no more than entertainment or recreation, will find it in this volume, in the 
copious illustrative facts and interesting collateral information, with which it 
abounds; whilst to the Agriculturist, the Gardener, and the Domestic Econo- 
mist, it supplies principles and practical applications of great importance." 

Philadelphia College of Pharmacy. — Dr. Robert Bridges has been appointed 
Prof, of Chemistry in this school, in the place of Wm. R. Fisher resigned. 

University of Maryland. — Dr. Joseph Roby has been appointed Prof, of 
Anatomy. 

Willoughhy Medical School.— Dr. Kirtland has accepted the Prof, of Theory 
and Practice of Medicine in this school. 

Pennsylvania Hospital. — Dr. William Pepper has been elected one of the phy- 
sicians to this hospital, in the place of Dr. Benjamin Coates resigned. Dr. 
Pepper is a well educated physician, very zealous in the pursuit of pathological 
investigations. This appointment will maintain the attractions of the hospital 
to students as a clinical school. 

Yellow Fever at Key West. — In our number for October, 1841, we inserted 
an article on this subject, sent to us by Dr. C. C. Dupre. We have since re- 
ceived a statement impugning the accuracy of the observations in that paper, and 
even denying that Dr. Dupre was on the Island during the period of the occur- 
rence of the yellow fever. Dr. Dupre is unknown to us, but his paper being well 
drawn up, and exhibiting every appearance of authenticity, we did not hesitate 
to give it an insertion, it being of course impossible for an editor to vouch for 
the truth of the statements made by his correspondents. We trust, however, 
that Dr. D. will be able to vindicate his character in this case; if he does not, 
we shall consider ourselves called on to publish in our next number, the docu- 
ment in our possession, which comes from a source, we are assured by one of 
our most respected collaborators, entitled to every confidence. 

Obituary. — It is with deep regret that we record the death of Dr. Daniel 
Oliver, Prof, of Materia Medica in the Medical College of Ohio, which took 
place at Cambridge, Mass. the first of June. Dr. Oliver was formerly Prof, of 
Theory and Practice of Medicine in Dartmouth College, N. H., and was the 
author of an admirable elementary work on Physiology. 



UNIVERSITY OF PENNSYLVANIA. 

MEDICAL DEPARTMENT.— SESSION 1842-43. 

The Lectures will commence on Tuesday, the first of November, and be con- 
tinued, under the following- arrangement, to the middle of March ensuing: — 
Practice and Theory of Medicine, - - by Nathaniel (Jhapman, M. D. 
Chemistry, ------ *' Robert Hare, M.D. 

Surgery, ------ «' William Gibson, M.D. 

Anatomy, *' William E. Horner, M. D. 

Institutes of Medicine, - - - - " Samuel Jackson, M. D. 
Materia Medica and Pharmacy, - - " George B. Wood, M.D. 
Obstetrics and the Diseases of Women and 

Children, " Hugh L. Hodge, M. D. 

A course of Clinical Lectures and Demonstrations, in connection with the above, is 
given at the very extensive and convenient Infirmary called the Philadelphia Hospital. 

Clinical Medicine, by W. W. Gerhard, M. D. 

Clinical Surgery, .-----" Drs. Gibson and Horner. 

Dr. Horner continues in public attendance at the said Hospital until August 1st; and 
as the tickets of admission are issued for one year from November 1st, they remain 
valid for his course, and the other service of the house, until the time expires. 

Clinical rnstruction in Medicine is also given from the 1st day of November to the 
1st day of March by Dr. Wood, in the Pennsylvania Hospital, an institution which is 
well known as one of the finest and best conducted Infirmaries in the United States. 

The rooms for Practical Anatomy will be opened October 1st, and continued so to 
the end of March. They are under the charge of Paul Beck Goddard, M.D., Demon- 
strator, with a supervision on the part of Dr. Horner. 

Copious additions to the very extensive cabinets of Anatomy, Materia Medica, Chem- 
istry, Surgery, and Obstetrics, have recently been made, and are in progress; the polity 
of the school being to give to its instructions, both Didactic and Clinical, a character as 
practical and influential as possible in imparling a sound Medical education. 

The Professor of Materia Medica, besides his Cabinet, has an extensive and well 
furnished Conservatory, from which are exhibited, in the fresh and growing state, the 
native and exotic Medicinal Plants. 

W. E. HORNER, M. D., 
Dean of the Medical Faculty^ 263 Chestnut Street, Philadelphia. 

Note. — A considerable number of the distinguished graduates of the school who are 
in connection with the Medical Department of the Guardians of the Poor, and with the 
different Dispensaries and Beneficiary establishments of the city, give Clinical and 
Elementary Instruction through the year, in private, and in their rounds of practice, to 
such gentlemen as desire it. 

July, 1842. 



MEDICAL COLLEGE OF THE STATE OF SOUTH CAROLINA. 

The regular course of Lectures in this Institution will be resumed on the 
second Monday in November. 

Anatomy, - - by J. E. Holbrook, M. D. 

Surgery, - - " E. Geddings, M. D. 

Institutes and Practice of Medicine, - - " S. Henrv Dickson, M. D. 

Physiology, " James Moultrie, M. D. 

Materia Medica " Henry R. Frost, M. D. 

Obstetrics, " Thomas G. Prtdleau, M.D. 

Chemistry, " C. U. Shepard, M. D. 

The school for Practical Anatomy has been reorganized, and will be under 
the charge of Prof. Holbrook, assisted by Drs. Desaussure, Chazal, Sinkler, 
Gaillard, and Ravenel. 

Clinical Instruction at College Hospital, Marine Hospital and Almshouse. 

HENRY R. FROST, Dean, 
1 



MEDICAL INSTITUTE OF PHILADELPHIA, 

LOCUST STREET, ABOVE ELEVENTH. 

The course of Lectures will commence on Monday, April 4th, and continae until 
the last of October ensuing, with the exception of August, which is a vacation. 

LECTURES. 

On Practice of Medicine by \ ^ ^t'^n^Z' ^* ?V t^ 

•' ^ W. W. Gerhard, M. D. 

A n.t«r«« 3 W. E. Horner, M. D. 

^""*°™y' )PaulB.Godd;rd,M.D. 
Institutes of Medicine, Samuel Jackson, M. D. 

Materia Medica and Therapeutics, John Bell, M. D. 

Obstetrics, and Diseases of Women j Hugh L. Hodge, M. D. 
and Children, f William Harris, M. D. 

Principle, and Practice of Surgery, j ^XSoohl"; M.D. 

W. E. HORNER, 

Secretary. 



JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA. 

Session OF 1842-43.. 

The regular Lectures will commence on the first Monday of November. 
RoBLEY DuNGLisoN, M. D,, Frofessor of Institutes of Medicine and Medical 

Jurisprudence . 
Robert M. Huston, M. D., Prof essor of Materia Medica and General Thera- 
peutics. 
Joseph Pancoast, M. D., Professor of General, Descriptive and Surgical 

Jlnatomy. 
J. K. Mitchell, M. D., Professor of Practice of Medicine. 
Thomas D. Mutter, M. D., Professor of Institutes and Practice of Surgery. 
Charles D. Meigs, M. D., Professor of Obstetrics and Diseases of Women 

and Children. 
Franklin Bache, M. D., Professor of Chemistry. 
Lectures and practical illustrations will be given at the Philadelphia Hospital 
regularly through the course, by 

Dr. Dunglison on Clinical Medicine, 
Dr. Pancoast on Clinical Surgery. 

On and after the first of October, the dissecting-room will be open, and the 
Professor of Anatomy and the Demonstrator, Dr. Jonathan M. Allen, will give 
their personal attendance thereto. Clinical instruction will likewise be given 
regularly at the Dispensary of the College. During the course, ample opportu- 
nities will be aiforded to students of the school for Clinical Instruction; Profes- 
sors Dunglison, Huston, and Pancoast being medical officers of the Philadelphia 
Hospital; Professor Meigs of the Pennsylvania Hospital; and Professor Mutter, 
Surgeon of the Philadelphia Dispensary. 

ROBERT M. HUSTON, M. D., Dean of the Faculty. 
*^* Boarding and other personal expenses of Students are at least as cheap 
in Philadelphia, as in any other city of the Union. 



COLLABORATORS. 



Elisha Bartlett, M. D. Professor of 
the Institutes and Practice of Medicine 
in Transylvania University . 

T. RoMEYN Beck, M. D. Professor of 
Materia Medica in the Albany Medi- 
cal College. 

John B. Beck, M.D., Prof, of Mat. 
Med. in the Coll. of Phys. ^ Surg. 
JV. York. 

Jacob Bigelow, M. D. Professor of Ma- 
teria Medica in Harvard University, 
Boston. 

A. Brigham, M. D. Superintendent and 
Physician to the Connecticut Retreat 
for the Insane. 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

Samuel Chew, M. D. Professor of 
Materia Medica in the University of 
Maryland. 

B. H. CoATES, M. D. of Philadelphia. 
D.Francis Condie, M. D, of Philadel- 
phia. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of the State of 
South Carolina. 

Gouverneur Emerson, M. D. of Phi- 
ladelphia. 

Charles Evans, M. D. Atteiiding Phy- 
sician to the Friends'' Asylum, Frank- 
ford. 

Paul F. Eve, M. D. Professor of Sur- 
gery in the Medical College of Geor- 
gia. 

John D. Fisher, M. D. of Boston. 

Samuel Forry, M. D. of New York. 

E. Geddings, M. D. Professor of Sur- 
gery in the Medical College of the State 
of South Carolina. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 

R. E. Griffith, M. D. late Professor of 
Medicine in the University of Virgi- 
nia. 

Thomas Harris, M. D. Surgeon U. S. 
Navy. 

E. Hale, M. D. Physician to the Mas- 
sachusetts General Hospital. 



Hugh L. Hodge, M. D. Prof, of Mid- 
wifery in the University of Penn. 

George Hay ward, M. D. Professor of 
the Principles of Surgery and Clinical 
Surgery in Harvard University, Bos- 
ton. 

Charles R. King, M. D. of New York. 

T. S, KiRKBRiDE, M. D. Physician to the 
Pennsylvania Hospital for the Insane, 

Samuel Jackson, M. D.Professorofthe 
Institutes of Medicine in the University 
of Pennsylvania. 

Samuel Jackson, M. D. Philadelphia. 

William E. Horner, M. D. Professor 
of Anatomy in the University of Penn- 
sylvania. 

C. A. Lee, M. D. of New York. 

Valentine Mott, M. D. Professor of 
Surgery in the University of New York. 

James McNaughton, M. D. Professor 
of the Theory and Practice of Medicine 
in Albany Medical College. 

Reuben D. Mussey, M. D. Professor of 
Surgery in the Medical College of Ohio. 

T. D. "Mutter, M. D. Professor of Sur- 
gery in Jefferson Medical College. 

G. W. NoRRis, M. D. one of the Sur- 
geons to the Pennsylvania Hospital. 

0. W. Pennock, M.D. one of the Phy- 
sicians to the Philadelphia Hospital, 
Blockley. 

Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Co- 
lumbian College, District of Columbia. 

Nathan R. Smith, M. D. of Baltimore. 

Thomas Stewardson, M. D. one of the 
Physicians to the Pennsylvania Hos- 
pital. 

Alfred Stille, M. D. of Philadelphia. 

John A. Swett, M. D. of New York. 

A. F. Vache, M. D. of New York. 

John Ware, M. D. Professor of the 
Theory and Practice of Physic in 
Harvard University, Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

Edward Warren, M. D, of Boston. 

John Watson, M. D. one of the Sur- 
geons of the New York Hospital. 

G, B. Wood, M. D. Professor of Ma- 
teria Medica and Pharmacy in the Uni- 
versity of Pennsylvania. 



EDITOR— Isaac Hays, M. D., one of the Surgeons to Wills Hospital for the 
Blind and Lame, ^c. 
No. VIII.— OcTOCER, 1842. 23 



PUBLISHERS' NOTICE. 



The Publishers respectfully request those subscri- 
bers who have not remitted the amount of their dues 
to forward them with as little delay as possible. 
Much inconvenience has arisen from the delay of 
payment by distant subscribers, and the publishers 
make this earnest appeal to them; and would at the 
same time solicit the medical profession generally 
throughout the States, to aid in the wider diffusion 
of this long established Journal. Devoted, as it has 
always been, to the best interests of the profession, 
an effort on the part of its members, would assist the 
proprietors in the improvement of the work, and en- 
able them to extend its sphere of usefulness. The 
beginning of the new year will, it is hoped, see this 
improvement, and no effort shall be wanting on their 
part to maintain the character which the Journal has 
sustained through a long series of years, at home as 
well as abroad. Remittances and orders can be made 
through the Postmasters free of expense. 

Philadelphia, October, 1842. 



TO READERS AND CORRESPONDENTS. 



The following- works have been received: — 

The History, Pathology, and Treatment of Puerperal Fever and Crural Phle- 
bitis. 1. A Treatise on the Epidemic Puerperal Fever of Aberdeen. By Alex. 
Gordon, M. D. 2.- A Treatise on the Puerperal Fever: illustrated by cases 
which occurred in Leeds and its vicinity in the years 1809-12. By Wm. Hev, 
Esq. 3. Facts and Observations relative to the fever commonly called Puerpe- 
ral. By John Armstrong, M. D. 4. On Puerperal Fever and Crural Phle- 
bitis. By Robert Lee, M. D. With an Introductory Essay, by Charles D. 
Meigs, M. D., Prof, of Obstetrics and Diseases of Women and Children in Jef- 
ferson Med. College. Philadelphia, 1842. (From Dr. Meigs.) 

Medical Communications of the Massachusetts Medical Society, vol. vii, pt. 
1. Boston, 1842. (From Dr. S. W. Williams.) 

Third Annual Report of the Registrar-General of Births, Deaths, and Mar- 
riages in England. London, 1841. (From the Registrar-General.) 

Proceedings of the Medical Society of the State of Tennessee, at their thir- 
teenth Annual Meeting, held in the city hall, Nashville, May, 1842. Nash- 
ville, 1842. (From the Society.) 

Catalogue of the Trustees, Faculty and Students of the Medical College of 
the State of South Carolina, 1842. (From the Faculty.) 

Quarterly Summary of the Transactions of the College of Physicians of Phila- 
delphia. May, June and July, 1842. (From the College.) 

A Treatise on Strabismus, with a description of new Instruments designed to 
improve the operation for its cure, in simplicity, ease and safety. Illustrated 
by cases. By James Bolton, M. D., A.M., &c. Richmond, 1842. (From 
the Author.) 

An Exposition of the Pathology of Hysteria, elucidated by a reference to the 
Origin, Diagnosis, Symptomatology, Pathology and Treatment of Hysterical 
Amaurosis. By Edward Octavius Hocken, M. D., &c. London, 1842. (From 
the Author.) 

A Treatise on the Diseases of the Heart and Great Vessels, and on the affec- 
tions which may be mistaken for them, &c. By J. Hope, M. D., F. R. S., &c. 
First American from the third London edition. With Notes, and a detail of 
recent Experiments. By C. W. Pennock, M. D., Attending Physician to the 
Philadelphia Hospital. Philadelphia: Haswell & Johnson, 1842. (From the 
Publishers.) 

Proceedings of the President and Fellows of the Connecticut Medical Soci- 
ety, in convention. May, 1842. Hartford, 1842. (From Dr. A. Welsh.) 

Catalogue of the Students and Graduates of the Spring term, 1842, and An- 
nual Announcement of the Fall Session, 1842. (From Dr. McClintock.) 

Annual Circular of the Medical Department of Kemper College; together 
with an Address delivered before the Alumni of the College at the commence- 
ment, March 1, 1842, by John S. Moore, M. D., Prof. Theory and Practice of 
Medicine. St. Louis, 1842. (From Prof. Moses.) 



268 TO READERS AND CORRESPONDENTS. 

Annual Announcement of the Medical College of Georgia. (From the 
Faculty.) 

An Address to the Graduating Class of the Medical College of Georgia. By 
Charles J. Jenkins, on the 4th of March, 1842. (From the Medical Faculty.) 

Charter, Constitution, and By-laws of the Medical Society of Missouri. St. 
Louis, 1842. (From the Society.) 

Elements of Surgery. By Robert Liston, Surgeon to the North-London 
Hospital, Professor of Clinical Surgery, &c. &c. From the second London 
edition, with copious Notes and Additions. By Samuel D. Gross, M. D., Prof. 
Surgery in the Louisville Medical Institute, &c. &c. Illustrated with nume- 
rous engravings. Philadelphia: Edw. Barrington & Geo. D. Haswell, 1842. 
(From the Publishers.) 

The Eighteenth Annual Report of the Officers of the Retreat for the Insane, 
at Hartford: Hartford, 1842. (From Dr. Brigham.) 

The Principles and Practice of Modern Surgery. By Robert Druitt. From 
the second London edition, illustrated with fifty wood engravings. With Notes 
and Comments, by Joshua B. Flint, M. D., M. M. S. S., Lecturer on Thera- 
peutic and Operative Surgery in the Louisville Acad, of Med., &c. &c. Phila- 
delphia: Lea & Blanchard, 1842. (From the Publishers.) 

Exposition of the Conduct and Character of Dr. John Augustine Smith, Pre- 
sident of the College of Physicians and Surgeons in the city of New York, and 
Professor of Physiology; as exhibited in the session of 1839-40. By James R. 
Manley, M. D., Late Lecturer on Obstetrics. New York, 1842. (From the 
Author.) 

Fourth Book of Natural History. Prepared for the use of Schools and Col- 
leges. By W. S. W. Ruschenberger, M. D., Surgeon U. S. Navy, &c. &c. 
Turner & Fisher, 1842. 

Introductory Lecture before the Medical Class in Castleton Medical College, 
at the opening of the Fall session, 1842. By D. M. Reese, A. M., M. D., Prof. 
Theory and Practice of Physic. Castleton, Vt., 1842. (From the Author.) 

Die Medicinal-Ordnung ine Grosherzogthum Mecklenburgh-Schwerin cri- 
lisch erortest von A. L. Dornbluth, M. D., &c. Gustrow, 1840. (From Dr. 
Oppenheim.) 

Medicinische Statistik der innerlichen Abtheilung des Catharinen-Hospitales 
zu Stuttgart in seinem ersten Decennium 1828-1838. Von Dr. Georg Cless. 
Stuttgart, 1841. (From Dr. Oppenheim.) 

Provincial Medical Journal and Retrospect of the Medical Sciences. June, 
July, and August, 1842. (In exchange.) 

The London Medical Gazette. May, June and July, 1842. (In exchange.) 

The Dublin Medical Press. June, July and August, 1842. (In exchange.) 

The London and Edinburgh Monthly Journal of Medical Science. Edited by 
John Rose Cormack, M. D. June, July, August, 1842. (In exchange.) 

The Edinburgh Medical and Surgical Journal. July, 1842. (In exchange.) 

The Medico-Chirurgical Review and Journal of Practical Medicine. July, 
1842. (In exchange.) 

The British and Foreign Medical Review, or Quarterly Journal of Practical 
Medicine and Surgery. July, 1842. (In exchange.) 



TO READERS AND CORRESPONDENTS. 269 

The Retrospect of Practical Medicine and Surgery, being a half yearly Jour- 
nal, containing a retrospective view of every discovery and practical improve- 
ment in the Medical Sciences. Edited by W. Braithwaite, Surgeon to the 
Leeds General Eye and Ear Infirmary. Jan., July, 1842. (In exchange.) 

Revue Medicale. Jan. Feb. March, Ap. May and June, 1842. (In ex- 
change.) 

Journal de Medecine et de Chirurgie Pratiques. Feb. March, Ap. May, June 
and July, 1842. (In exchange.) 

Journal des Connaissances Medico-Chirurgicales, Feb, March, Ap. May, 
June, 1842. (In exchange.) 

Gazette Medicale de Paris. Jan. Feb. March, April, May, and June, 1842. 
(In exchange.) 

Journal des Connaissances Medicales Pratiques et de Pharmacologic, Jan. 
Feb. March, April, June, 1842. (In exchange.) 

Journal de Pharmacie et de Chimie. Feb. March, April, May, and June, 1842. 
(In exchange.) 

L'Examinateur Medicale. Jan. Feb. March, April, May, June, 1842. (In 
exchange.) 

Zeitschrift fiir die gesammte Medicin, mit besonderer Riicksicht auf Hospital- 
praxis und auslandische Literatur. Herausgegeben F. W. Oppenheim. Sep. 
Oct. Nov. Dec. 1841, Jan. Feb. March, 1842. (In exchange.) 

Jahrbuch der gesammten Staatsarzneikunde. Herausgegeben von Dr. C. F. 
L. WiLDBERG. Vol. vi, No. 3, vol. vii, No. 1 and 2. (From Dr. Oppenheim.) 

Archief voor genecskunde. Door Dr. J. P. Heije, 1841. (From Dr. Oppen- 
heim.) 

Wenken en Meeningen omtrent geneeskundige Staatsregeling en Algemeene 
geneskunde. Door J. P. Heije. 1841. (From Dr. Oppenheim.) 

Boston Medical and Surgical Journal. July, Aug. and Sept. 1842. (In 
exchange.) 

The Medical Examiner, July, Aug. and Sept. 1842. (In exchange.) 

The New York Medical Gazette, July, 1842. (In exchange.) 

The Guardian of Health. July, 1842. (In exchange.) 

The American Journal of Science and the Arts. July, 1842. (In exchange.) 

The American Medical Library and Intelligencer. June, 1842. 
(In exchange.) 

The Select Medical Library and Bulletin of Medical Science. July, 1842. 
(In exchange.) 

The New York Lancet. July, Aug. and Sept. 1842. (In exchange.) 

The Western Lancet. July and August, 1842. (In exchange.) 

The American Journal of Pharmacy. July, 1842. (In exchange.) 

The Maryland Medical and Surgical Journal. April and Sept. 1842. (In 
exchange.) 

The Western Journal of Medicine and Surgery. July, Aug. 1842. (In ex- 
change.) 

Q;y^ The advertisement sheet belongs to the business department of the 
Journal, and all communications for it should be made to the publishers 

23* 



270 TO READERS AND CORRESPONDENTS. 

under whose exclusive control it is. The editor does not even revise the proof 
sheets. 

Communications intended for publication, and Books for Review, should be 
sent,/ree of expense, directed to Isaac Hays, M. D,, Editor of the Amer. Journ. 
of Med. Sci., care of Messrs. Lea & Blanchard, Philadelphia. Parcels directed 
as above, and sent (carriage paid) under cover, to John Miller, Henrietta Street, 
Covent Garden, London, or to Wiley & Putnam, New York, or W. D. Ticknor, 
Boston, will reach us safely. We particularly request the attention of our 
foreign correspondents to the above, as we are often subjected to unnecessary 
expense for postage and carriage. 

All remittances of money and letters on the business of the Journal, should be 
addressed exclusively to the publishers, Messrs. Lea & Blanchard. .^ 



m: 



CONTENTS 

OF THE 

AMERICAN JOURNAL 

I OF THE 

MEDICAL SCIENCES. 

No. VIII, NEW SERIES. 

OCTOBER, 1842. 

ORIGINAL COMMUNICATIONS. 

MEMOIRS AND CASES. 

ART. PAGE. 

I. Osteo-Sarcoma of Lower Jaw — Amputation — Cure. By Charles Bell 
Gibson, M. D., of Baltimore. 277 

II. On Cimicifuga and Iodine in Phthisis Pulmonalis. By Chas. 0. Hil- 
dreth, M. D., of Zanesville, Ohio. 281 

III. On Typhoid Pneumonia, as it occurs in the neighbourhood of Co- 
lumbia, S. C. By R. W. Gibbes, M. D., of Columbia, S. C. - - 289 

IV. On the use of the unripe fruit of the Diospyros Virginiana, as a The- 
rapeutic Agent. By John P. Mettauer, M. D., of Virginia. - - - 297 

V. On Endemic Sore Mouth and Diarrhoea peculiar to Nursing Women. 

By Lewis Shanks, M. D., of Memphis, Tennessee. _ _ > _ 300 

VI. On the Treatment of Deformities, following unsuccessfully treated 
Fractures. By George W. Norris, M. D., one of the Surgeons to the 
Pennsylvania Hospital. -.-.-_-_. 305 

VII. Two cases of Black Vomit, with Observations. By Richard D. Arnold, 

M. D., of Savannah. 316 

VIII. Paralysis of the Face, successfully treated with Strychnine. By 

B. F. Joslin, M. D., of the city of New York. 322 

IX. Remarks on the propriety and best manner of breaking and extract- 
ing large Calculi in the lateral operation. By Josiah C. Nott, M. D., 

of Mobile. 328 

X. Aneurism of the Femoral Artery, showing the importance of applying a 
ligature below, as well as above the Sac. By Wm. E. Horner, M.D., 
Professor of Anatomy in the University of Pennsylvania, Surgeon at the 
Philadelphia Hospital, &c. 332 

XL Plastic Operations. By J. Pancoast, M.D., Professor of Anatomy in 
Jefferson Medical College. - - - - 337 

XII. Treatment of Hemorrhoids. By Wm, E. Horner, Professor of Ana- 
tomy in the University of Pennsylvania. 358 

XIII. Suggestion as to the Cause of the Crepitant Rhonchus. By Edson 
Carr, M. D., of Canandaigua, N. Y. 360 

XIV. On Creasote in diseases of the Conjunctiva and Cornea. By Chas. 

C. Hildreth, M. D., of Zanesville, Ohio. 362 

XV. Chronic Enlargement of the Spleen. By N. S. Davis, M. D., of 
Binghamton, N. Y. - - - 367 

XVI. Case of Gelatinous Polypus, cured with Sanguinaria Canadensis 
after extraction had twice failed. By Lewis Shanks, M. D., of Mem- 
phis, Tennessee. 368 



272 CONTENTS. 

ART. PAGE. 

XVH. Case of Spontaneous Rupture of the Spleen. By John Neill, 
M. D. - - 369 

XVIII. Operation for Artificial Pupil. By Isaac Hays, M. D., Surgeon to 
Wills Hospital. 371 

XIX. Improvement on the Tourniquet, by Silon A. Henkel, M. D., of 
New Market, Va. - - - 373 

REVIEWS. 

XX. Du Traitement Moral de la Folie. Par F. Leuret, Medecin de I'Hos- 
pice de Bicetre. Paris, 1840: pp. 4fi2. 

On the Moral Treatment of Insanity. By F. Leuret, Physician to the Bi-' 
cetre Asylum. Paris: 1840. 375 

XXI. Medicinische Statistik der innerlichen Abtheilung des Catharinen- 
Hospitales zu Stuttgart, in seinem ersten Decennium, 1828 — 1838. Von 
Dr. Georg- Cless. Mit einer Lithographie und sieben Tabellen. Stutt- 
gart; Verlag von Ebner & Seubert, 1841. 

Medical Statistics of the Interior Division of the Catharine-Hospital at 
Stuttgart, during its first decennium, 1828—1838. By Dr. George Cless. 
With one lithograph and seven tables. Stultgart: Ebner & Seubert, 
1841, quarto, pp. 96. 388 

BIBLIOGRAPHICAL NOTICES. 

XXII. The History, Pathology, and Treatment of Puerperal Fever and 
Crural Phlebitis. I. A Treatise on the Epidemic Puerperal Fever of Aber- 
deen. By Alexander Gordon, M. D. II. A Treatise on the Puerperal 
Fever, illustrated by cases which occurred in Leeds and its vicinity, in 
the years 1809-12. By William Hey, Esq. III. Facts and Observations 
relative to the Fever, commonly called Puerperal. By John Armstrong, 
M. D. IV. On Puerperal Fever and Crural Phlebitis. By Robert Lee, 
M.D., F. R. S. With an Introductory Essay. By Charles D. Meigs, 

M. D., Slc. Philadelphia: 1842. Barrington and Haswell, 8vo. pp. 338. 399 

XXIII. Specimen Medicum Inaugurale, de Morbosa Gazorum Secretione. 
Auctore J. L. Siemens. Groningen, 1841: 8vo. pp. 64. 

On the Morbid Secretion of Gases. By J. L. Siemens. _ . _ 402 

XXIV. Om de Sanitaire Forholde i Faengsler efter nyere Systemer, Ved 
Professor Frederik Hoist, M. D. 

The Influence of the New Penitentiary System upon the Health of the 
Prisoners. By Professor F. Hoist, M. D. 8vo. pp. 30: Christiania, 1840. 405 

XXV. The Eighteenth Annual Report of the Officers of the Retreat for 

the Insane at Hartford. Hartford, 1842, pp. 36. 407 

XXVI. Quarterly Summary of the Transactions of the College of Physi- 
cians of Philadelphia, May, June, and July, 1842, pp. 24, 8vo. - - 410 

XXVII. Third Annual Report of the Registrar-General of Births, Deaths, 
and Marriages in England. London, 1841: pp. 362, 12mo. - - - 418 

XXVIII. A Treatise on the Diseases of the Heart and Great Vessels, and on 
the affections which may be mistaken for them. Comprising the Author's 
view of the Physiology of the Heart's Action and Sounds, as demonstrated 
by his Experiments on the Motions and Sounds in 1830, and on the Sounds 
in 1834-5. By J. Hope, M. D., F. R. S., of St. George's Hospital; for- 
merly Senior Physician to the Marylebone Infirmary; Extraordinary 
Member, and formerly President, of the Royal Medical Society of Edin- 
burgh, &c. First American from the third London edition. With Notes, 
and a Detail of recent Experiments. By C. W. Pennock, M. D., Attending 
Physician to the Philadelphia Hospital, Blockley. Philadelphia: Lea & 
Blanchard, 1842: 8vo. pp, 572, plates ix, •. 430 



CONTENTS. 273 

ART. PAGE. 

XXIX. Cours de Pathologie et de Therapeutique Generales, fait a la Faculte 
de Medecine de Paris, par M. Andral; compte-rendu par M. Monneret, 
agrege pres cette Faculte, Medecin de bureau central. Gazette Medicale 

de Paris, 10 Sept. 1841, 432 

XXX. The Principles and Practice of Modern Surgery. By Robert Druitt. 
"Id potissimum agens, ut omissis hypothesibus, in praxi nihil adstruat 
quod multiplici experientia non sit roboratum." — Act. Erud. Lips. 1722. 
From the second London Edition, Illustrated with fifty wood Engrav- 
ings; with Notes and Comments. By Joshua B. Flint, M.D.— MM. SS., 
Lecturer on Therapeutic and Operative Surgery in the Louisville Acad- 
emy of Medicine, and late Professor of Surgery in the Medical Institute 

of Louisville. Philadelphia: Lea and Blanchard, 1842; 8vo. pp. 534. - 439 

XXXI. Medical Communications of the Massachusetts Medical Society. 
Vol. vii, pt. 1. Second Series, vol. iii, pt. 1. Boston, 1842: pp. 76, 8vo. 440 

XXXII. A Series of Anatomical Plates; with References and Physiological 
Comments, illustrating the Structure of the different parts of the Human 
Body. Edited by Jones Quain, M. D., Prof, of Anat. and Phys. in the Uni- 
versity of London, and W. J. Erasmus Wilson, Lecturer on Practical and 
Surgical Anatomy and Physiology. By Joseph Pancoast, M. D., Professor 
of Genera], Descriptive, and Surgical Anatomy in the Jefferson Medical 
College of Philadelphia, Lecturer on Clinical Surgery to the Philadel- 
phia Hospital, &c. &c. American edition revised, with additional notes. 
Philadelphia: Carey & Hart, for G. N. Loomis, 1842: 4to. pp. 445, and 
200 plates. - 440 

XXXIII. A Treatise on Amaurosis and Amaurotic Affections. By Edward 
Octavius Hocken. Philadelphia: Haswell and Johnson, 1842: pp. 
201, 8vo. 

An exposition of the Pathology of Hysteria; elucidated by a reference to the 
Origin, Diagnosis, Symptomatology, Pathology and Treatment of Hyste- 
rical Amaurosis. By Edward Octavius Hocken, M. D., M. R. C. S. L., 
&c. London; Samuel Highley, 1842: pp. 32, 12mo. - - - » 440 

XXXIV. Elements of Surgery. By Robert Liston, Surgeon to the North- 
London Hospital, Prof, of Clinical Surgery, &c. &c. &c. From the 
second London edition, with copious Notes and Additions. By Samuel 
D. Gross, M.D., Prof, of Surg, in the Louisville Medical Institute, Sur- 
geon to the Louisville Marine Hospital, &c. &c. Illustrated with numerous 
engravings. Philadelphia, Edvv. Barrington & Geo. D. Haswell, 1842: 
pp. 640, 8vo. 441 

XXXV. A Treatise on Strabismus, with a description of new instruments 
designed to improve the operation for its Cure in simplicity, ease and 
safety, illustrated by cases. By James Bolton, M. D., A. M., Member of 
the Medical Society of Virginia. Richmond, 1842: pp. 36, 12mo., plate 1. 441 

XXXVI. A Treatise on the Diseases of the Eye. By V^. Lawrence, F. R. 
S.; Surgeon Extraordinary to the Queen; Surgeon to St. Bartholomews, 
and Lecturer on Surgery at that Hospital; late Surgeon to the London 
Ophthalmic Infirmary, &c. &c. Second edition, revised, corrected and 
enlarged. London, 1841. 8vo. pp. 820. ---_., 441 

XXXVII. Three Memoirs on the Development and Structure of the Teeth 
and Epithelium, read at the ninth annual meeting of the British Associa- 
tion for the encouragement of Science, held at Birmingham, in August 
1839; with Diagrams exhibited in illustration. By Alexander Nasymth, 
F. L. S., F. G. S., Member of the Royal College of Surgeons. London: 
John Churchill, 1841: 8vo. pp. 47. - - - -° - - - 442 

XXXVUI. The Anatomist's Vade Mecum; a System of Human Anatomy. 
By Erasmus Wilson. Second edition. London. 1842: 8vo., pp. 595. 
With 167 illustrations by Bagg. 442 



274 



CONTENTS. 



SUMMARY 



IMPROVEMENTS AND DISCOVERIES 
MEDICAL SCIENCES. 



IN THE 



FOREIGN INTELLIGENCE. 

Anatomy and Physiology. 



L Cases proving the Influence of 
the Cerebro-Spinal Axis in the 
production of Animal Heat. By 
M. Brugnoli. - - - 

Influence of the Nerves on 
Muscular Irritability. By M. 
Lontret. - - - - 

Influence of the Pneumogastric 
Nerve on the movements of the 
stomach. By M. Longet. - 

4. On the Blood-globules, their 
Formation and their Use. By M. 



2. 



3. 



- 443 



- 444 



444 



Donne. - . - - - 
5. On the Eflfects of an imperme- 
able covering applied to the 
Skin. By MM. Becquerel and 
Breschet. - - _ - 

On the Coloration of the Bones 
by Madder. By MM. Serres and 
Doyere. 

Physiological Observations on 
Double Uterus. By M. Dumas. 

Transposition of the Viscera. 
By M. Gerdy. 



PAGE 

■ 444 



445 



445 



447 



447 



Materia Medica and Pharmacy. 



9. Emmenagogue Solution. By 

M. Bouchardat. . - - 447 

10. Chalybeate Preparations. By 
Mr. Wm. Tyson. - - - 448 

11. Mode of preserving Nitrate 

of Silver. By M. Dumeril. - 449 



12. External application of Cro- 

ton Oil. 449 

13. On the use of the Ergot of 
Rye. By Dr. Geo. Fife. - - 449 

14. Ergot of Rye. By Dr. Wm. 
Catlett. 450 

15. Ergot. By M. Bonjean. - 451 



Medical Pathology and Therapeutics and Practical Medicine. 



16. Observations on the Preven- 
tion and Treatment of Apoplexy 
and Hemiplegia. By Dr. Mar- 
shall Hall. - - - - 452 

17. Quantity of Blood virithin the 
Cranium. By Mr. Jolly. - 455 

18. Blood in the Brains of Ani- 
mals bled to death. By Mr. 
Crisp. 456 

19. Belladonna in Epilepsy. By 
Dr. Debreyne. - - - - 456 

20. Nature and Treatment of 
Scrofula. By Dr. Roesch. - 457 

21. State of the Blood in Hydro- 
phobia. By Prof. Berres. - 457 

22. Disease of the Kidney. By 
Dr. Barlow. - - - - 457 

23. Simple and Double Pneumo- 



thorax. By Dr. Puchelt, Jr. 

24. Influence of Light on the de^ 
velopment of the Small-pox Pus 
tule. By M. Serres. 

25. Urea secreted in large quan- 
tity by the peritoneum in a case 
of Ascites. By Prof. Kane. 

26. Nature and Treatment of Stri- 
dulous Convulsion in Infants. 
By Marshall Hall, M. D. - 

27. Two fatal cases of Laryngis- 
mus Stridulus. By Mr. F. Ry- 
land. . . . - - 

28. Statistics of Phthisis. By Dr. 
Hughes. - - - • 

29. Statistical Researches into the 
Etiology of Pulmonary Phthisis. 
By M. Briquet. 



458 



- 459 



459 



459 



462 



- 464 



465 



CONTENTS. 



275 



Surgical Pathologv and Therapeutics and Operative Surgery. 



PAGE 

30. Ecchymosis from injury sim- 
ulating- laceration of an artery 

of the part. By Dr. Houston. 465 

31. Rupture of the Urethra, with 
extravasation of urine into the 
scrotum and penis. By Dr. 
Bellingham. - - - -467 

33. Spontaneous Fracture of the 
Thigh-bone. By Mr. Toogood, 
and Mr. Salter. - - - 469 

33. Fracture of the Thigh by mus- 
cular contraction. By M. Nara- 
novitch. ----- 470 

34. Dislocation of the Lower 
Jaw. By Mr. D. Donovan. - 470 

35. Benzoic Acid in Urinary Dis- 
orders. By Dr. J. K. Walker, 
and Mr. J. S. Soden. - - 470 

36. Post-mortem Examination of 
the Duke of Orleans. - - 472 

37. Caries of the tenth and 
eleventh Ribs — Excision — Cure. 

By M. Jaequet. - - - 473 

38. Superficial Cancers. By M. 
Lisfranc. 474 

39. Ununited Fracture of the Hu- 
merus cured by the insertion of a 



Seton at two different periods. 
By MM. Mawroury and Thore. 

40. Tumours in the Bladder. By 
Mr. Douglas. - - - - 

41. Scriveners' Spasm cured by 
division of muscles. By Prof. 
Stromeyer. - - - - 

42. Tumours developed on Cica- 
trices. By M. Gimelle. • 

43. Fracture of Cranium with 
considerable loss of the sub- 
stance of the Brain. By Dr. 
Zartmann. 

44. Ligature of the Subclavian 
and Arteria Innominata arteries 
for wound in the Arm-pit. By 
M. Hutin. - - - 

45. Nature and Treatment of 
common Toothache. By Mr. 
T. Wilkinson King-. 

46. On the Operation of Tracheo- 
tomy in Croup, performed at the 
Children's Hospital, and on its 
results. By B. A. Becquerel, 
M. D. - - - ■ 

47. Statistics of Dislocations. By 
M. Malgaigne. - - - 



475 



475 



476 



- 476 



- 477 



- 477 



- 478 



- 478 



480 



Ophthalmology. 



48. On a peculiar affection of the 
Cornea in nurses. By Professor 
Nasse. - - - - . 481 

49. Entropion. By Dr. Jacob. - 481 

50. Intermittent Amaurosis. By 
Dr. Stoeber. - - - - 481 

51. Hereditary Ptosis. By Dr. 



Alessi. . - - - - 

52. Wound of the Orbit — Rupture 
of the Optic Nerve. By Mr. 
Phillips. - - - - - 

53. Belladonna as a douche in 
some forms of Ophthalmic dis- 
ease. By F. A. Bulley, Esq. 



Midwifery. 



482 



482 



483 



54. Four children at a Birth. By 
Dr. Biggs. - - - - 485 

55. Spontaneous gangrene of the 
Cervix Uteri and part of the 
Vagina. By M. Baron. - - 485 



56. Occurrence of confluent Small- 
pox in a child before birth, with- 
out any similar eruption appear- 
ing on the mother, who had been 
vaccinated. By Dr. C. Gnoli. 485 



Medical Jurisprudence and Toxicology. 
By 



57. Death from Lightning. 
Professor Carresi. - - . 435 

58. Unsuccessful attempt at Sui- 
cide. 486 

59. Spontaneous Ecchymosis re- 
sembling external injury. By 
Dr. Lados. - - - - 486 

60. Poisoning with Verdigris. - 487 



61. Poisoning by the liquor of In- 
digo Blue. - - . - 487 

62. Instant Death from a wound 

of the Stomach. - - - 487 

63. Dr. Brett on detecting minute 
portions of Arsenic and Anti- 
mony. 487 

64. Signs of Maturity in new-born 



276 



CONTENTS. 



Children. - - - - 

65. Poisoning by Sulphuric Acid 
— detected in the tJrine. By 
Dr. Scoffern. - 

66. Experiments on the action of 
hydrated peroxide of Iron on Ar- 
senic. By M. Guibert. 

67. Shall an accused person be 
allowed Medical Counsel? 

68. Protracted Gestation. 

69. Poisoning of the East India 
Company's camels in Caubul, 
by Digitalis. . - - - 

70. Verguin on the Detection of 
Copper in Medico-legal Analy- 
sis. - 



PAGE 

489 



- 489 



489 

490 
491 



491 



- 491 



PAGE 

• 492 



- 493 



493 



71. Ergot. By Bonjean. 

72. On the Action of Water on 
Lead. By Prof. Christison 

73. Feigned Diseases Bloody 

Urine. - - . - - 

74. Compound poisoning with 
Arsenic and Opium. - - 494 

75. Absorption of various Mineral 
Poisons. By M. Orfila. - - 494 

76. Corpora Lutea. By Dr. Wm. 
Davidson. - - - - 495 

77. Superfoetation. By M. Dumas. 495 

78. Connection of precipitate La- 
bour with Mania. - - - 495 

79. Antidote to Corrosive Subli- 
mate. By M. Mialhe. - - 496 



Organic Chemistry. 



80. Organic Chemistry applied to 
Physiology and Pathology. By 
Dr. Playfair. - - - - 496 

81. Azotized Nutritive Principles 
of Plants. By M. Liebig. -501 

Miscellaneous 

84. Homoeopathy. . _ - 

85. Destruction of the Medical Li- 
brary at Hamburg, in the recent 
conflagration. - - - - 

86. Vaudeville enacted in a Lunatic 
Asylum. ----- 

87. Revivification of Microscopic 
Animalculae. By M. Milne Ed- 
wards. - - - . - 



82. Composition of Animal Sub- 
stances. By M. Bouchardat. - 504 

83. Analysis of the menstrual 
Fluid. By M. Bouchardat. - 504 



505:88. 


Health of Paris. - 


- 506 




89. 


Health of London. 


- .506 




90. 


London Schools. - 


- 507 


50591. 


University of Edinburgh. 


- 507 


92. 


Medical Faculty of Paris. 


- 507 


50593. 


Honours to Medical Men. 


- 507 




94. 


Obituary Record. - 


- 507 




95. 


New French Medical Works 


508 


506 









AMERICAN INTELLIGENCE. 



Mania from decayed Teeth. By 
Dr. W^m. Mendenhall. 

Excision of the upper Maxillary 
Bone. By R. D. Mussey, M. D., 
&c. 

Ununited Fracture of the Fore-arm, 
of four years' standing. By Dr 
Chas. S. Tripler, U. S. A. 

Femoral Aneurism — Ligature of 
the external Iliac— Death on the 
fifth day. By W. Power, M. D. 

Immovable Apparatus. By Dr. 
Geo. Hayward. 

Fracture of the Patella. By Geo 
Hayward, M. D. 

Enlargement of Bursa over Patel- 
la. By Geo. Hayward, M. D. - 

Opium in Strangulated Hernia. By 
Dr. A. B. Shipman. - 

Alcohol detected in the Brain. By 
Dr. Lewis. - - - . 

Leeching in Erysipelas. By Dr. 



509 



509 



- 510 



511 



- 512 



- 512 



513 



- 514 



Geo. Hayward. - - - 516 

Subcutaneous Division of the Mas- 

seter Muscle. By Dr. .1. W. 

Schmidt. 516 

Hydrated Peroxide of Iron. By 

Wm. Proctor, Jr. - - - 517 
Oxide of Silver. By M. Augustine 

Duhamel. - - - . 517 

Ligature of the common Iliac. By 

Dr. Edward Peace. - - - 517 
Dr. Harris's case of Resection of 

the Elbow-joint. , - - 517 
Substitute for a Warm-bath. By 



Dr. Hale. - - - - 517 

Immovable Apparatus. - - 518 

Connecticut Medical Society. - 518 
Medical Society of the State of 

Tennessee. _ - - - 5I8 
Medical College of Georgia. - 518 
Kemper College. - - - 518 
515'Ruschenberger's Natural History. 518 
lExpulsion. 518 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



OCTOBER, 1842. 



Art. I. — Osteosarcoma of Lower Jaw — Amputation — Cure. By Charles 
Bell Gibson, M. D., of Baltimore. [With two wood-cuts.] 

Moses Lee, blacksmith, fifty-one years of age, of robust make and active 
habits, a slave belonging to the estate of the late Richard 0. Grayson, of 
Loudon county, Virginia, was placed in my hands in April 1842, for the 
treatment of a tumour involving a large portion of the os maxillare in- 



ferius. About six years since, 
whilst engaged in ploughing, 
some obstacle occurring in the 
course of his furrow, caused 
the handle of his plough to 
be thrown violently upwards,, 
striking him severely in the 
centre of the chin, and produc- 
ing very severe pain in the 
part for a few days. In less 
than a week afterwards he 
discovered a slight swelling 
immediately over the spot, but 
as the pain had ceased, he 
paid little attention to it, unless 
when starded by a sponta- 
neous jet of blood which oc- 
casionally occurred from be- 
tween the first incisors of each 
side. The tumour increased 
slowly, at the end of a year 
No. VIII.— October, 1842 



Fig. 1. 




3,# 



i •'!*• 



278 Gibson's Case of Osteo- Sarcoma. [Oct. 

having attained the size of a hickory-nut. From that period until I saw 
it, it increased more rapidly, but without pain; the only inconvenience being 
the difficulty of articulation and deglutition. The sketch Fig. 1, gives a faith- 
ful representation of his appearance, previous to the operation. The tumour 
was confined to the lower jaw, having sprung apparently from the spot where 
the blow was received, directly in the middle of the chin, and extending itself 
with great regularity towards the angles of the bone. The limit of the dis- 
ease was evidendy just in front of the first molar tooth on each side, the 
measurement from one point to the other being exactly fourteen inches. 

In an upward direction it extended nearly to the roof of the mouth, hav- 
ing pushed from their sockets all the incisors, the cuspid, and one of the 
bicuspids on both sides of the upper jaw, and separating the lips vertically 
to the extent of four and a half inches. Within the mouth and below, it 
extended along the under surface of the tongue to the anterior border of the 
sublingual gland, just in front of which, the uniformity of the surface was 
broken by a rising, or lobe, of the size of a black walnut, on which rested 
part of the under surface of the tongue. Over the whole surface of the 
tumour, which was intensely red, large veins were freely distributed, and 
at points in front were two deep ulcerations, from which, as well as from 
numerous small openings, was discharged a yellowish sero-purulent matter, 
small in quantity, and possessing but little odour. To the touch the gene- 
ral impression was hard, though in some places an elastic, and in others a 
decidedly fluctuating sensation was evident, especially in front, and where 
the tumour protruded between the lips. I performed the operation on the 
12th of April at 12 o'clock, in the presence of a number of the medical 
men of this city. I am particularly indebted to Drs. Baxley, T. Buckler and 
Theobald, for their valuable aid on the occasion. 

The patient was seated in an ordinary chair, his head supported by an 
assistant. Standing in front, I made the first incision three-fourths of an 
inch to the left of the median line through the thickness of the lower lip 
in a straight line down as far as the diseased mass could be felt, an extent 
of about seven inches. The second incision was precisely similar at the 
same distance from the median line on the right side, thus leaving attached 
to the tumour an inch and a half in width of lip and integuments, which, it 
was thought, would be superfluous in the union to be eflTected after the re- 
moval of the tumour. 

A dissection was now rapidly made from the point of the first incision to 
the second molar tooth; the first molar on this side was now extracted by 
the dentist's key in order to remove with more facihty the bone, just ante- 
rior to the second molar, and thus insure, as far as possible, the removal of 
all the diseased portion. The same course was followed on the right side. 
I now took a position directly behind the patient, his head resting on my 
breast, and the flap on the left side being held out of the way, sawed from above 
downwards through the bone on that side, cutting through the cavity occu- 



1842.] Gibson's Case of Osteo- Sarcoma. 279 

pied by the roots of the extracted molar. In the same way the right side 
of the bone was sawn through. Coming again in front and grasping the 
mass with the left hand, it was easily brought away by dividing its connec- 
tions with the digastric, mylo-hyoid and genio-hyo-glossus muscles. The 
hemorrhage from the cavity thus exposed was profuse. The submental and 
inferior coronary branches of the facial artery of both sides were easily se- 
cured, but the ranineand sublingual arteries gave us very considerable trouble, 
retiring out of sight, and from increasing weakness of the patient giving a 
scarcely perceptible jet. We removed him into the open air in a yard 
adjoining the room, and this with the aid of some wine and water, in about 
twenty minutes caused his pulse to rise, and the bleeding vessels were 
secured. From the division of the genio-hyo-glossus muscle, considerable 
inconvenience was produced in the disposition in the tongue to turn over and 
point down the pharynx. 

A ligature passed through the frasnum and secured, after the dressing of 
the wound was completed, to an iron wire contrivance, remedied the incon- 
venience. The apparatus consisted of an upright on either side of the head, 
having a horizontal position on a line with the mouth, and projecting some 
three inches beyond it. A single piece of iron wire was procured and bent 
for the purpose. Having carefully examined and determined the complete 
extirpa^tion of the diseased bone, the edges of the wound were brought to- 
gether an^ retained by hare-lip pins and the interrupted suture. Straps 
and roller completed the dressing, and the patient was put to bed. The 
oozing of blood continuing considerable, a piece of fine sponge was steeped 
in the muriated tincture of iron, and introduced into the mouth. The dis- 
charge was then entirely arrested. 

Moses bore the operation extremely well. When put to bed his pulse 
was 60; feeble, but very even and regular. During the rest of the day he 
took occasionally a little very fluid barley water, finding considerable diffi- 
culty in swallowing. The evening and night he appeared comfortable, not 
complaining, and sleeping for the most part. Two medical students sat up 
with him through the night, and continued to do so as long as it was neces- 
sary. 

£pril ISth. Find Moses doing extremely well; I have removed the 
sponge and wire apparatus, the disposition to swallow the tongue having 
ceased; pulse 62, regular; very litde pain in the part. I have removed him 
to-day to a room in my own dwelling, where I can see him at any time more 
conveniently. He has taken to-day weak coflee and chicken water, swal- 
lowing readily by means of a catheter secured to a " sick cup." 3 P. M. 
Pulse 64, regular. 

14^^. About 7 o'clock last evening his pulse rose to 80, without much 
heat of skin. The lips have become much swollen, with considerable heat; 
applied the sub. acet. plumbi dilut., and opened his bowels by a simple 
enema; he slept well through the night; this morning at nine dressed the 



28a 



Gibson's Case of Osteo- Sarcoma. 



[Oct. 



wound; it looks remarkably well, all below the lip having united by the 
first intention except where the ligatures protrude; pulse 70; lip still much 
swollen. 3 o'clock P. M. Moses has walked down stairs, and is now in 
the garden; same diet. 7 P. M. Pulse 74. 

\Uh. Dressed the wound; very little discharge; lip continues much 
swelled and presents quite a sulcus above the first pin. He has been 
down stairs nearly all day walking about; spirits good; appetite famous. 

16//i. Passed a good night; swelling of lip subsiding; the upper pin came 
away to-day in dressing the wound. He has eaten to-day a large dish of 
mush besides his soup and barley water. 

llth. After dinner to-day found Moses complaining a little of weakness; 
perhaps from over-exertion in walking about. Gave him some weak brandy 
toddy. 10 P. M. Stronger; pulse 70. 

ISth. Passed a very good night. Dressed the wound, and removed the 
last pin; two ligatures came away also. Diet to-day oysters and beer. 

19;/i. Passed last night without having any one with him. Dressed the 
wound which has healed throughout, except at the upper part of the lip for 
about the eighth of an inch. This spot is improving under the nitrate of 
silver. The other ligatures were pulled away to-day. 

26/A. Moses has returned to Virginia to-day. Nothing worthy of notice 



Fig. 2. 




has occurred since the last date. 
He has gone for the last three 
days without a bandage or strap 
of any kind. A thick line down 
the middle of his chin is the only 
evidence of his having submitted 
to an operation. There is very 
little deformity; the thick integu- 
ments most naturally represent- 
ing the absent anterior portion of 
his maxilla inferior. 

Fig. 2, represents the present 
appearance of Moses accurately. 
It only remains to be stated, that 
sections of the removed tumour 
made in various directions veri- 
fied in all respects the description 
of the structure of osteo-sarcoma. 



Baltimore, 1842. 



gire 



1842.] Hildreth on Cimicifuga and Iodine in Phthisis Pulmonalis. 281 



Art. II. — On Cimicifuga and Iodine in Phthisis Pulmonalis. By Chas. 
C. Hildreth, M. D., of Zanesville, Ohio. 

To whom we are indebted for the original introduction to the notice of the 
profession, of the black snakeroot in phthisis, I am not able to discover. 
My attention was first directed to it by an article published in one of our 
'western journals some eight or nine years since. But as the physician 

porting the cases did not appear familiar with auscultation, and, of course, 
said nothing of the pathological state of the lungs of his patients, his com- 
munication on this account lost much of its interest. 

My object here is to direct the attention of the profession to the use of 
the cimicifuga in the incipient stage of phthisis, when that train of constitu- 
tional symptoms is induced by the presence of induration, or tubercle, in the 
upper lobes, which even the common observer, without a knowledge of 
auscultation, will but too frequently, and justly, pronounce consumption. 

In the latter stage of the disease, when tubercles are softened and exca- 
vated, and pus in abundance is thrown up, I should not expect much from 
this, or any other known treatment. 

Here it may be asked, how are we to distinguish the disease in its early 
stage before those pathological lesions are induced in the lungs, which ren- 
der it so truly a disgrace to the healing art? Any modern treatise on auscul- 
tation, will tell us on what physical, as well as rational signs to rely for a 
diagnosis. 

Our best authors divide phthisis into three stages, in accordance with the 
pathological lesions: — 

''''The first stage is that of the formation of induration, whether granular 
or diffused. The second, is that of the conversion of those indurations into 
yellow tubercles, with the extension of this lesion to other parts. The 
third, is that of their softening and evacuation, and the formation of vomica." 

The more readily to explain our views of the treatment of phthisis in its 
early stages, a few cases will be reported. 



Case I. Phthisis complicated with general bronchitis. S. C , aetat. 

45, of strong constitution and temperate habits, residing two and a half 
miles from Zanesville, after atmospheric exposure, contracted bronchitis. 
This occurred in the early part of May, 1841. Supposing that he had 
simply " taken cold," as he ex